Polymyositis and dermatomyositis physical examination: Difference between revisions

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*Physical examination of patients with polymyositis and dermatomyositis is usually remarkable for:[finding 1], [finding 2], and [finding 3].
*Physical examination of patients with polymyositis and dermatomyositis is usually remarkable for:[finding 1], [finding 2], and [finding 3].
*The presence of gottron's papules and the heliotrope eruption on physical examination is pathognomonic of dermatomyositis.
*The presence of gottron's papules and the heliotrope eruption on physical examination is pathognomonic of dermatomyositis.
*The presence of [finding(s)] on physical examination is highly suggestive of [disease name].


===Appearance of the Patient===
===Appearance of the Patient===
*Patients with [disease name] usually appear [general appearance].  
*Patients with polymyositis and dermatomyositis usually appear normal. They might be weak in severe cases.  


===Vital Signs===
===Vital Signs===


*High-grade / low-grade fever
*Low-grade fever
*[[Hypothermia]] / hyperthermia may be present
*[[Tachycardia]] with regular pulse or (ir)regularly irregular pulse
*[[Bradycardia]] with regular pulse or (ir)regularly irregular pulse
*Tachypnea / bradypnea
*Kussmal respirations may be present in _____ (advanced disease state)
*Weak/bounding pulse / pulsus alternans / paradoxical pulse / asymmetric pulse
*High/low blood pressure with normal pulse pressure / [[wide pulse pressure]] / [[narrow pulse pressure]]


===Skin===
===Skin===
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===HEENT===
===HEENT===
* HEENT examination of patients with [disease name] is usually normal.
* Periorbital swelling
OR
===Neck===
* Abnormalities of the head/hair may include ___
* Neck examination of patients with polymyositis and dermatomyositis is usually normal.
* Evidence of trauma
* Icteric sclera
* [[Nystagmus]]
* Extra-ocular movements may be abnormal
*Pupils non-reactive to light / non-reactive to accommodation / non-reactive to neither light nor accommodation
*Ophthalmoscopic exam may be abnormal with findings of ___
* Hearing acuity may be reduced
*[[Weber test]] may be abnormal (Note: A positive Weber test is considered a normal finding / A negative Weber test is considered an abnormal finding. To avoid confusion, you may write "abnormal Weber test".)
*[[Rinne test]] may be positive (Note: A positive Rinne test is considered a normal finding / A negative Rinne test is considered an abnormal finding. To avoid confusion, you may write "abnormal Rinne test".)
* [[Exudate]] from the ear canal
* Tenderness upon palpation of the ear pinnae/tragus (anterior to ear canal)
*Inflamed nares / congested nares
* [[Purulent]] exudate from the nares
* Facial tenderness
* Erythematous throat with/without tonsillar swelling, exudates, and/or petechiae


===Neck===
*
* Neck examination of patients with [disease name] is usually normal.
OR
*[[Jugular venous distension]]
*[[Carotid bruits]] may be auscultated unilaterally/bilaterally using the bell/diaphragm of the otoscope
*[[Lymphadenopathy]] (describe location, size, tenderness, mobility, and symmetry)
*[[Thyromegaly]] / thyroid nodules
*[[Hepatojugular reflux]]


===Lungs===
===Lungs===
* Pulmonary examination of patients with [disease name] is usually normal.
* Asymmetric chest expansion
OR
* Asymmetric chest expansion / Decreased chest expansion
*Lungs are hypo/hyperresonant
*Lungs are hypo/hyperresonant
*Fine/coarse [[crackles]] upon auscultation of the lung bases/apices unilaterally/bilaterally
*Fine [[crackles]] upon auscultation of the lung 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
*[[Bronchophony]] present/absent
*Normal/reduced [[tactile fremitus]]


===Heart===
===Heart===
* Cardiovascular examination of patients with [disease name] is usually normal.
* Cardiovascular examination of patients with polymyositis and dermatomyositis is usually normal.
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.
* Abdominal examination of patients with polymyositis and dermatomyositis is usually normal.
 
OR
*[[Abdominal distention]]
*[[Abdominal tenderness]] in the right/left upper/lower abdominal quadrant
*[[Rebound tenderness]] (positive Blumberg sign)
*A palpable abdominal mass in the right/left upper/lower abdominal quadrant
*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.
* Back examination of patients with polymyositis and dermatomyositis is usually normal.
OR
*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.
* Genitourinary examination of patients with polymyositis and dermatomyositis is usually normal.
OR
*A pelvic/adnexal mass may be palpated
*Inflamed mucosa
*Clear/(color), foul-smelling/odorless penile/vaginal discharge
 
===Neuromuscular===
===Neuromuscular===
*Patient is usually oriented to persons, place, and time
*Patient is usually oriented to persons, place, and time
* Symmetric proximal muscle weakness mostly in:
* Symmetric proximal [[muscle weakness]] mostly in:
**Deltoids
**Deltoids
**Hips
**Hips
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* Mild distal muscle weakness
* Mild distal muscle weakness


* Hyperreflexia / hyporeflexia / areflexia
* Hyporeflexia / areflexia
* Positive (abnormal) Babinski / plantar reflex unilaterally/bilaterally
* Muscle rigidity
* 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.
*Muscle atrophy in severe, long standing disease  
OR
*[[Clubbing]]
*[[Cyanosis]]
*Pitting/non-pitting [[edema]] of the upper/lower extremities
*Muscle atrophy in severe, longstanding disease
*Fasciculations in the upper/lower extremity
*Fasciculations in the upper/lower extremity


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}

Revision as of 20:29, 4 April 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sadaf Sharfaei M.D.[2]

Overview

Physical Examination

  • Physical examination of patients with polymyositis and dermatomyositis is usually remarkable for:[finding 1], [finding 2], and [finding 3].
  • The presence of gottron's papules and the heliotrope eruption on physical examination is pathognomonic of dermatomyositis.

Appearance of the Patient

  • Patients with polymyositis and dermatomyositis usually appear normal. They might be weak in severe cases.

Vital Signs

  • Low-grade fever

Skin

  • Skin eruptions like:
    • Gottron's papules is pathognomonic of dermatomyositis.
    • Heliotrope eruption is pathognomonic of dermatomyositis.
    • Gottron's sign
    • Facial erythema
    • Photodistributed poikiloderma
    • Nailfold changes
    • Scalp involvement
    • Calcinosis cutis
    • Mechanic's hands
    • Cutaneous ulceration

HEENT

  • Periorbital swelling

Neck

  • Neck examination of patients with polymyositis and dermatomyositis is usually normal.

Lungs

  • Asymmetric chest expansion
  • Lungs are hypo/hyperresonant
  • Fine crackles upon auscultation of the lung bilaterally
  • Wheezing may be present

Heart

  • Cardiovascular examination of patients with polymyositis and dermatomyositis is usually normal.

Abdomen

  • Abdominal examination of patients with polymyositis and dermatomyositis is usually normal.

Back

  • Back examination of patients with polymyositis and dermatomyositis is usually normal.

Genitourinary

  • Genitourinary examination of patients with polymyositis and dermatomyositis is usually normal.

Neuromuscular

  • Patient is usually oriented to persons, place, and time
  • Symmetric proximal muscle weakness mostly in:
    • Deltoids
    • Hips
    • Neck flexors
  • Mild distal muscle weakness
  • Hyporeflexia / areflexia
  • Muscle rigidity

Extremities

  • Muscle atrophy in severe, long standing disease
  • Fasciculations in the upper/lower extremity

References

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