Behçet's disease physical examination: Difference between revisions
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===Skin=== | ===Skin=== | ||
* Skin examination of patients with | * Skin examination of patients with Behcet disease shows the following: | ||
**Erythema nodosum lesions typically occur on the extremities, especially the lower legs, but they can also be observed on the face, neck, and buttocks | |||
Erythema nodosum lesions typically occur on the extremities, especially the lower legs, but they can also be observed on the face, neck, and buttocks | **The lesions are painful and resolve spontaneously, although some may ulcerate or leave hyperpigmentation | ||
**A folliculitislike rash, resembling acne vulgaris, appears on the face, neck, chest, back, and hairline of patients | |||
**Some lesions become more pustular; 24-48 hours after a sterile needle prick, some patients develop erythema with a nodule or pustule at the prick site | |||
===HEENT=== | ===HEENT=== | ||
Revision as of 01:51, 23 April 2018
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Hamid Qazi, MD, BSc [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 Behcet disease is usually remarkable for: skin lesions, genital lesions, and neuromuscular complications.
Appearance of the Patient
- Patients with Behcet disease usually appear normal.
Vital Signs
- Normal
Skin
- Skin examination of patients with Behcet disease shows the following:
- Erythema nodosum lesions typically occur on the extremities, especially the lower legs, but they can also be observed on the face, neck, and buttocks
- The lesions are painful and resolve spontaneously, although some may ulcerate or leave hyperpigmentation
- A folliculitislike rash, resembling acne vulgaris, appears on the face, neck, chest, back, and hairline of patients
- Some lesions become more pustular; 24-48 hours after a sterile needle prick, some patients develop erythema with a nodule or pustule at the prick site
HEENT
- 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 retinal vasculitis, vaso-occlusive lesions
- Uveitis of anterior and posterior chambers diagnosed with slit-lamp examination[13]
- Erythematous throat with tonsillar swelling, and exudates
- Ulcers 2-15 mm in diameter, with a necrotic center and surrounding red rim
- A white or yellow pseudomembrane covers the surface of the ulcer
- The ulcers are typically painful, nonscarring, and found on the lips, buccal mucosa, tongue, tonsils, and larynx
- Most last 7-14 days and occur in crops
- hypopyon may be observed in the anterior chamber
Neck
- Neck examination of patients with Behcet disease is usually normal.
Lungs
- Pulmonary examination of patients with Behcet disease is usually normal.
Heart
- Cardiovascular examination of patients with Behcet disease is usually normal.
Abdomen
Abdominal examination of patients with Behcet disease is usually normal.
Back
- Back examination of patients with Behcet disease is usually normal.
Genitourinary
- Genitourinary examination of patients with Behcet disease will show:
- Ulcers on the scrotum and vulva, painful and heal with scarring
- Genital ulcerations tend to be deeper and larger than the oral lesions
- Females can have asymptomatic ulcers
Neuromuscular
- Neuromuscular examination of patients with [disease name] 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)
CNS involvement occurs in as many as 25% of patients and may be the most serious manifestation of disease. The immune-mediated meningoencephalitis that is most commonly seen predominantly involves the brainstem. Dural venous sinus thrombosis is less common. Findings may include meningitis, encephalitis, focal neurological deficits, and psychiatric symptoms. The CNS lesions may have exacerbations and remissions. In some patients, irreversible dementia ultimately results.
Extremities
- Monoarthritis or polyarthritis
- Knees are the most commonly affected joints, followed by wrists, ankles, and elbows
- The arthritis is typically nonerosive
