Scleroderma physical examination: Difference between revisions

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==Physical Examination==
==Physical Examination==
* Physical examination of patients with [disease name] is usually normal.
*Physical examination of patients with scleroderma is usually remarkable for:[finding 1], [finding 2], and [finding 3].
OR
*Physical examination of patients with [disease name] is usually remarkable for:[finding 1], [finding 2], and [finding 3].
*The presence of [finding(s)] on physical examination is diagnostic of [disease name].
*The presence of [finding(s)] on physical examination is diagnostic of [disease name].
*The presence of [finding(s)] on physical examination is highly suggestive of [disease name].
*The presence of [finding(s)] on physical examination is highly suggestive of [disease name].
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===Vital Signs===
===Vital Signs===
*Normal
*Vital signs of patients with scleroderma are usually normal


===Skin===
===Skin===
*Skin induration<ref name="pmid23541012">{{cite journal |vauthors=Shah AA, Wigley FM |title=My approach to the treatment of scleroderma |journal=Mayo Clin. Proc. |volume=88 |issue=4 |pages=377–93 |date=April 2013 |pmid=23541012 |pmc=3666163 |doi=10.1016/j.mayocp.2013.01.018 |url=}}</ref>
*Skin induration<ref name="pmid23541012">{{cite journal |vauthors=Shah AA, Wigley FM |title=My approach to the treatment of scleroderma |journal=Mayo Clin. Proc. |volume=88 |issue=4 |pages=377–93 |date=April 2013 |pmid=23541012 |pmc=3666163 |doi=10.1016/j.mayocp.2013.01.018 |url=}}</ref>
*Skin fibrosis
*Skin fibrosis
*Dilatation of nailfold capillaries
*Telangiectasias
*Telangiectasias
*Calcinosis
*Calcinosis


===HEENT===
===HEENT===
* HEENT examination of patients with [disease name] is usually normal.
*HEENT examination of patients with scleroderma is usually normal.
OR
* Abnormalities of the head/hair may include ___
* 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===
* Neck examination of patients with [disease name] is usually normal.
*Jugular venous distention maybe present suggesting right heart failure due to pulmonary hypertension.
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.
*Pulmonary examination of patients with scleroderma is usually normal.
OR
*Inspiratory [[crackles]] upon auscultation of the lung are suggestive of interstitial lung disease.
* Asymmetric chest expansion / Decreased chest expansion
*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
*[[Egophony]] present/absent
*[[Bronchophony]] present/absent
*Normal/reduced [[tactile fremitus]]


===Heart===
===Heart===
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===Back===
===Back===
* Back examination of patients with [disease name] is usually normal.
* Back examination of patients with scleroderma 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 scleroderma is usually normal.
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.
*Neuromuscular examination of patients with scleroderma is usually normal.
OR
*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===
*Myopathy<ref name="pmid23541012">{{cite journal |vauthors=Shah AA, Wigley FM |title=My approach to the treatment of scleroderma |journal=Mayo Clin. Proc. |volume=88 |issue=4 |pages=377–93 |date=April 2013 |pmid=23541012 |pmc=3666163 |doi=10.1016/j.mayocp.2013.01.018 |url=}}</ref>
*Myopathy<ref name="pmid23541012">{{cite journal |vauthors=Shah AA, Wigley FM |title=My approach to the treatment of scleroderma |journal=Mayo Clin. Proc. |volume=88 |issue=4 |pages=377–93 |date=April 2013 |pmid=23541012 |pmc=3666163 |doi=10.1016/j.mayocp.2013.01.018 |url=}}</ref>
*Ulceration of finger tips (ischemic)
*Ulceration of finger tips (ischemic)
*Contraction (flexure)
*Contractures of finger flexion
*Raynaud's phenomenon
*Raynaud's phenomenon<ref name="pmid12324557">{{cite journal |vauthors=Wigley FM |title=Clinical practice. Raynaud's Phenomenon |journal=N. Engl. J. Med. |volume=347 |issue=13 |pages=1001–8 |date=September 2002 |pmid=12324557 |doi=10.1056/NEJMcp013013 |url=}}</ref>
*Dilatation of nailfold capillaries
*Sclerodactyly


==References==
==References==

Revision as of 22:54, 17 April 2018

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

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].

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 of patients with scleroderma is usually remarkable for:[finding 1], [finding 2], and [finding 3].
  • The presence of [finding(s)] on physical examination is diagnostic of [disease name].
  • The presence of [finding(s)] on physical examination is highly suggestive of [disease name].

Appearance of the Patient

  • Patients with [disease name] usually appear [general appearance].

Vital Signs

  • Vital signs of patients with scleroderma are usually normal

Skin

  • Skin induration[1]
  • Skin fibrosis
  • Telangiectasias
  • Calcinosis

HEENT

  • HEENT examination of patients with scleroderma is usually normal.

Neck

  • Jugular venous distention maybe present suggesting right heart failure due to pulmonary hypertension.

Lungs

  • Pulmonary examination of patients with scleroderma is usually normal.
  • Inspiratory crackles upon auscultation of the lung are suggestive of interstitial lung disease.

Heart

  • Cardiovascular examination of patients with [disease name] 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
  • S1
  • S2
  • S3
  • S4
  • 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

Abdominal examination of patients with [disease name] is usually normal.

OR

Back

  • Back examination of patients with scleroderma is usually normal.

Genitourinary

  • Genitourinary examination of patients with scleroderma is usually normal.

Neuromuscular

  • Neuromuscular examination of patients with scleroderma is usually normal.

Extremities

  • Myopathy[1]
  • Ulceration of finger tips (ischemic)
  • Contractures of finger flexion
  • Raynaud's phenomenon[2]
  • Dilatation of nailfold capillaries
  • Sclerodactyly

References

  1. ↑ 1.0 1.1 Shah AA, Wigley FM (April 2013). "My approach to the treatment of scleroderma". Mayo Clin. Proc. 88 (4): 377–93. doi:10.1016/j.mayocp.2013.01.018. PMC 3666163. PMID 23541012.
  2. ↑ Wigley FM (September 2002). "Clinical practice. Raynaud's Phenomenon". N. Engl. J. Med. 347 (13): 1001–8. doi:10.1056/NEJMcp013013. PMID 12324557.

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