Undifferentiated connective tissue disease physical examination: Difference between revisions

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==Overview==
==Overview==
Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].
Patients with UCTD usually appear well but can present with low-grade [[fever]], [[Raynaud's phenomenon]], [[Rash|rash and]] [[Erythema nodosum]]. On HEENT examination, [[Conjunctivitis]], [[Uveitis]], [[Keratoconjunctivitis sicca]][[Dry-mouth|, dry-mouth]] can be seen. In the neck, [[lymphadenopathy]] can be seen. Rhonchi, [[Wheezing]][[Pleural friction rub|, pleural friction rub]] and [[Pericardial friction rub]] can be heard on auscultation. On examining abdomen, [[tenderness]] in the right/left upper/lower abdominal quadrant and [[hepatomegaly]] may be noted. In the back, tenderness over the lumbar vertebrae can occur and sacral [[edema]] may be seen. [[Rashes|Rash]] can be seen in the genitourinary exam. The patient can have [[altered mental status]] with [[psychosis]] and [[peripheral neuropathy]] and pitting/non-pitting [[edema]] of the lower extremities.
 
OR
 
Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].
 
OR
 
The presence of [finding(s)] on physical examination is diagnostic of [disease name].
 
OR
 
The presence of [finding(s)] on physical examination is highly suggestive of [disease name].


==Physical Examination==
==Physical Examination==
*The presence of following findings on physical examination is highly suggestive of undifferentiated connective tissue disease(UCTD):<ref name="pmid12846049">{{cite journal |vauthors=Bodolay E, Csiki Z, Szekanecz Z, Ben T, Kiss E, Zeher M, Szücs G, Dankó K, Szegedi G |title=Five-year follow-up of 665 Hungarian patients with undifferentiated connective tissue disease (UCTD) |journal=Clin. Exp. Rheumatol. |volume=21 |issue=3 |pages=313–20 |date=2003 |pmid=12846049 |doi= |url=}}</ref>
*The presence of following findings on physical examination is highly suggestive of undifferentiated connective tissue disease(UCTD):<ref name="pmid12846049">{{cite journal |vauthors=Bodolay E, Csiki Z, Szekanecz Z, Ben T, Kiss E, Zeher M, Szücs G, Dankó K, Szegedi G |title=Five-year follow-up of 665 Hungarian patients with undifferentiated connective tissue disease (UCTD) |journal=Clin. Exp. Rheumatol. |volume=21 |issue=3 |pages=313–20 |date=2003 |pmid=12846049 |doi= |url=}}</ref><ref name="pmid17110308">{{cite journal |vauthors=Mosca M, Tani C, Neri C, Baldini C, Bombardieri S |title=Undifferentiated connective tissue diseases (UCTD) |journal=Autoimmun Rev |volume=6 |issue=1 |pages=1–4 |date=November 2006 |pmid=17110308 |doi=10.1016/j.autrev.2006.03.004 |url=}}</ref><ref name="pmid10544849">{{cite journal |vauthors=Mosca M, Neri R, Bombardieri S |title=Undifferentiated connective tissue diseases (UCTD): a review of the literature and a proposal for preliminary classification criteria |journal=Clin. Exp. Rheumatol. |volume=17 |issue=5 |pages=615–20 |date=1999 |pmid=10544849 |doi= |url=}}</ref>


===Appearance of the Patient===
===Appearance of the Patient===
*Patients with UCTD usually appear [general appearance].  
*Patients with UCTD usually appear well..  


===Vital Signs===
===Vital Signs===
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* [[Lymphadenopathy]] (describe location, size, tenderness, mobility, and symmetry)
* [[Lymphadenopathy]] (describe location, size, tenderness, mobility, and symmetry)
===Lungs===
===Lungs===
* Asymmetric chest expansion / Decreased chest expansion
* Rhonchi
*Lungs are hypo/hyperresonant
*Fine/coarse [[crackles]] upon auscultation of the lung bases/apices unilaterally/bilaterally
*Rhonchi
*Vesicular breath sounds / Distant breath sounds
*Expiratory/inspiratory wheezing with normal / delayed expiratory phase
*[[Wheezing]] may be present
*[[Wheezing]] may be present
*[[Egophony]] present/absent
*[[Pleural friction rub]]
*[[Bronchophony]] present/absent
*Normal/reduced [[tactile fremitus]]


===Heart===
===Heart===
* Cardiovascular examination of patients with [disease name] is usually normal.
* [[Pericardial friction rub]]
OR
*Chest tenderness upon palpation
*PMI within 2 cm of the sternum  (PMI) / Displaced point of maximal impulse (PMI) suggestive of ____
*[[Heave]] / [[thrill]]
*[[Friction rub]]
*[[Heart sounds#First heart tone S1, the "lub"(components M1 and T1)|S1]]
*[[Heart sounds#Second heart tone S2 the "dub"(components A2 and P2)|S2]]
*[[Heart sounds#Third heart sound S3|S3]]
*[[Heart sounds#Fourth heart sound S4|S4]]
*[[Heart sounds#Summation Gallop|Gallops]]
*A high/low grade early/late [[systolic murmur]] / [[diastolic murmur]] best heard at the base/apex/(specific valve region) may be heard using the bell/diaphgram of the otoscope
 
===Abdomen===
===Abdomen===
Abdominal examination of patients with [disease name] is usually normal.
OR
*[[Abdominal distention]]
*[[Abdominal tenderness]] in the right/left upper/lower abdominal quadrant  
*[[Abdominal tenderness]] in the right/left upper/lower abdominal quadrant  
*[[Rebound tenderness]] (positive Blumberg sign)
*[[Rebound tenderness]]  
*A palpable abdominal mass in the right/left upper/lower abdominal quadrant
*[[Hepatomegaly]]  
*Guarding may be present
*[[Hepatomegaly]] / [[splenomegaly]] / [[hepatosplenomegaly]]
*Additional findings, such as obturator test, psoas test, McBurney point test, Murphy test


===Back===
===Back===
* Back examination of patients with [disease name] is usually normal.
*Tenderness over lumbar vertebrae can occur
OR
*Sacral [[edema]] may be seen
*Point tenderness over __ vertebrae (e.g. L3-L4)
*Sacral edema
*Costovertebral angle tenderness bilaterally/unilaterally
*Buffalo hump


===Genitourinary===
===Genitourinary===
* Genitourinary examination of patients with [disease name] is usually normal.
*[[Rashes]] can be seen
OR
*A pelvic/adnexal mass may be palpated
*Inflamed mucosa
*Clear/(color), foul-smelling/odorless penile/vaginal discharge


===Neuromuscular===
===Neuromuscular===
* Neuromuscular examination of patients with [disease name] is usually normal.
* Altered mental status with psychosis
OR
* [[Peripheral neuropathy]]
*Patient is usually oriented to persons, place, and time
* Altered mental status
* Glasgow coma scale is ___ / 15
* Clonus may be present
* Hyperreflexia / hyporeflexia / areflexia
* Positive (abnormal) Babinski / plantar reflex unilaterally/bilaterally
* Muscle rigidity
* Proximal/distal muscle weakness unilaterally/bilaterally
* ____ (finding) suggestive of cranial nerve ___ (roman numerical) deficit (e.g. Dilated pupils suggestive of CN III deficit)
*Unilateral/bilateral upper/lower extremity weakness
*Unilateral/bilateral sensory loss in the upper/lower extremity
*Positive straight leg raise test
*Abnormal gait (describe gait: e.g. ataxic (cerebellar) gait / steppage gait / waddling gait / choeiform gait / Parkinsonian gait / sensory gait)
*Positive/negative Trendelenburg sign
*Unilateral/bilateral tremor (describe tremor, e.g. at rest, pill-rolling)
*Normal finger-to-nose test / Dysmetria
*Absent/present dysdiadochokinesia (palm tapping test)


===Extremities===
===Extremities===
* Extremities examination of patients with [disease name] is usually normal.
*Pitting/non-pitting [[edema]] of the lower extremities.
OR
*[[Clubbing]]
*[[Cyanosis]]
*Pitting/non-pitting [[edema]] of the upper/lower extremities
*Muscle atrophy
*Fasciculations in the upper/lower extremity


==References==
==References==

Latest revision as of 18:23, 30 May 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:

Overview

Patients with UCTD usually appear well but can present with low-grade fever, Raynaud's phenomenon, rash and Erythema nodosum. On HEENT examination, Conjunctivitis, Uveitis, Keratoconjunctivitis sicca, dry-mouth can be seen. In the neck, lymphadenopathy can be seen. Rhonchi, Wheezing, pleural friction rub and Pericardial friction rub can be heard on auscultation. On examining abdomen, tenderness in the right/left upper/lower abdominal quadrant and hepatomegaly may be noted. In the back, tenderness over the lumbar vertebrae can occur and sacral edema may be seen. Rash can be seen in the genitourinary exam. The patient can have altered mental status with psychosis and peripheral neuropathy and pitting/non-pitting edema of the lower extremities.

Physical Examination

  • The presence of following findings on physical examination is highly suggestive of undifferentiated connective tissue disease(UCTD):[1][2][3]

Appearance of the Patient

  • Patients with UCTD usually appear well..

Vital Signs

Skin

HEENT

Neck

  • Lymphadenopathy (describe location, size, tenderness, mobility, and symmetry)

Lungs

Heart

Abdomen

Back

  • Tenderness over lumbar vertebrae can occur
  • Sacral edema may be seen

Genitourinary

Neuromuscular

Extremities

  • Pitting/non-pitting edema of the lower extremities.

References

  1. ↑ Bodolay E, Csiki Z, Szekanecz Z, Ben T, Kiss E, Zeher M, Szücs G, Dankó K, Szegedi G (2003). "Five-year follow-up of 665 Hungarian patients with undifferentiated connective tissue disease (UCTD)". Clin. Exp. Rheumatol. 21 (3): 313–20. PMID 12846049.
  2. ↑ Mosca M, Tani C, Neri C, Baldini C, Bombardieri S (November 2006). "Undifferentiated connective tissue diseases (UCTD)". Autoimmun Rev. 6 (1): 1–4. doi:10.1016/j.autrev.2006.03.004. PMID 17110308.
  3. ↑ Mosca M, Neri R, Bombardieri S (1999). "Undifferentiated connective tissue diseases (UCTD): a review of the literature and a proposal for preliminary classification criteria". Clin. Exp. Rheumatol. 17 (5): 615–20. PMID 10544849.

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