<prompt> Answer this question truthfullyWhat does a physical examination for toxic shock syndrome involve?  <response>: <reason> Physical exam in TSS patients usually include these findings: TSS is presented by its shock symptoms. May be ill appearing in the early stages of the disease, progress to confusion and change in mental status by disease progress.High grade Fever Hypotension Systolic blood pressure of 90 mmHg for adults or less than fifth percentile by age for children 16 years of age, which may be unresponsive to fluid infusion even large amounts of isotonic intravenous fluids Tachycardia As a result of shock and hypotension Tachypnea May be pressent as a result of pulmonary edema secondary to shockDiffuse pruritic maculopapular rash with palm and soles desquamation Erythroderma Superficial ulcerations Petechiae Vesicles Bullae specially in Streptococcal TSS Skin desquamation apears weeks after disease onset Non-pitting edema Hair and nail lossCyanosisOphthalmoscopic exam may be abnormal with findings of conjunctival - scleral hemorrhage Hyperemia of oropharyngeal mucosaWet rales due to pulmonary edema complicationPossibly a diastolic gallop S3 due to pulmonary edemaNon-pitting edema Can develop as a result of increases in interstitial fluidPatient is usually oriented but if the disease is not diagnosed, it can lead to altered mental status and confusion Hyporeflexia can be seen as a result of associated hypocalcemia hypophosphatemia Muscle cramps as a result of hypocalcemia, a contributing complication of renal failure Seizure 