Fibromuscular dysplasia physical examination: Difference between revisions
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==Physical Examination== | ==Physical Examination== | ||
*Physical examination of patients with fibromuscular dysplasia | *Physical examination of patients with fibromuscular dysplasia is usually normal. However the most common presentation of [[renal artery]] FMD is [[renovascular hypertension]], but in the physical examination of patients enrolled in the US registry for fibromuscular dysplasia mean blood pressure was 130/75 mm Hg.<ref>{{Cite journal | ||
| author = [[Jeffrey W. Olin]], [[James Froehlich]], [[Xiaokui Gu]], [[J. Michael Bacharach]], [[Kim Eagle]], [[Bruce H. Gray]], [[Michael R. Jaff]], [[Esther S. H. Kim]], [[Pam Mace]], [[Alan H. Matsumoto]], [[Robert D. McBane]], [[Eva Kline-Rogers]], [[Christopher J. White]] & [[Heather L. Gornik]] | | author = [[Jeffrey W. Olin]], [[James Froehlich]], [[Xiaokui Gu]], [[J. Michael Bacharach]], [[Kim Eagle]], [[Bruce H. Gray]], [[Michael R. Jaff]], [[Esther S. H. Kim]], [[Pam Mace]], [[Alan H. Matsumoto]], [[Robert D. McBane]], [[Eva Kline-Rogers]], [[Christopher J. White]] & [[Heather L. Gornik]] | ||
| title = The United States Registry for Fibromuscular Dysplasia: results in the first 447 patients | | title = The United States Registry for Fibromuscular Dysplasia: results in the first 447 patients | ||
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*Focal neurological deficits,[[cranial nerve]] involvement, [[pupil]] abnormality or [[ptosis]] (findings consistent with [[Horner syndrome]]) may be detected in FMD. | *Focal neurological deficits,[[cranial nerve]] involvement, [[pupil]] abnormality or [[ptosis]] (findings consistent with [[Horner syndrome]]) may be detected in FMD. | ||
===Appearance of the Patient=== | ===Appearance of the Patient=== | ||
*Patients with | *Patients with FMD usually appear normal. | ||
===Vital Signs=== | ===Vital Signs=== | ||
*High | *High blood pressure with normal pulse pressure may be seen among patients with renovascular FMD. | ||
===Skin=== | ===Skin=== | ||
*Skin examination of patients with | *Skin examination of patients with FMD is normal. | ||
===HEENT=== | ===HEENT=== | ||
*HEENT examination of patients with [disease name] is usually normal. | *HEENT examination of patients with [disease name] is usually normal. | ||
| Line 160: | Line 132: | ||
===Extremities=== | ===Extremities=== | ||
*Extremities examination of patients with [disease name] is usually normal. | *Extremities examination of patients with [disease name] is usually normal. | ||
==References== | ==References== | ||
Revision as of 13:17, 27 July 2018
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Fibromuscular dysplasia Microchapters |
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Diagnosis |
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Treatment |
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ASA/ACCF/AHA Guideline Recommendations |
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Management of Patients With Fibromuscular Dysplasia of the Extracranial Carotid Arteries |
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Case Studies |
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Fibromuscular dysplasia physical examination On the Web |
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American Roentgen Ray Society Images of Fibromuscular dysplasia physical examination |
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Risk calculators and risk factors for Fibromuscular dysplasia physical examination |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
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].
Physical Examination
- Physical examination of patients with fibromuscular dysplasia is usually normal. However the most common presentation of renal artery FMD is renovascular hypertension, but in the physical examination of patients enrolled in the US registry for fibromuscular dysplasia mean blood pressure was 130/75 mm Hg.[1]
- The presence of carotid bruits on physical examination has low sensitivity however its specificity for identifying extracranial FMD is highly suggestive.
- The presence of an epigastric or flank bruit on physical examination, such as carotid bruits is low, however, its presence strongly suggestive of renal or mesenteric FMD.
- Focal neurological deficits,cranial nerve involvement, pupil abnormality or ptosis (findings consistent with Horner syndrome) may be detected in FMD.
Appearance of the Patient
- Patients with FMD usually appear normal.
Vital Signs
- High blood pressure with normal pulse pressure may be seen among patients with renovascular FMD.
Skin
- Skin examination of patients with FMD is normal.
HEENT
- HEENT examination of patients with [disease name] 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 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
- Pulmonary examination of patients with [disease name] is usually normal.
OR
- Asymmetric chest expansion OR decreased chest expansion
- Lungs are hyporesonant OR hyperresonant
- Fine/coarse crackles upon auscultation of the lung bases/apices unilaterally/bilaterally
- Rhonchi
- Vesicular breath sounds OR distant breath sounds
- Expiratory wheezing OR inspiratory wheezing with normal OR delayed expiratory phase
- Wheezing may be present
- Egophony present/absent
- Bronchophony present/absent
- Normal/reduced tactile fremitus
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
- 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 examination of patients with [disease name] is usually normal.
OR
- Point tenderness over __ vertebrae (e.g. L3-L4)
- Sacral edema
- Costovertebral angle tenderness bilaterally/unilaterally
- Buffalo hump
Genitourinary
- Genitourinary examination of patients with [disease name] is usually normal.
OR
- A pelvic/adnexal mass may be palpated
- Inflamed mucosa
- Clear/(color), foul-smelling/odorless penile/vaginal discharge
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)
Extremities
- Extremities examination of patients with [disease name] is usually normal.
References
- ↑ Jeffrey W. Olin, James Froehlich, Xiaokui Gu, J. Michael Bacharach, Kim Eagle, Bruce H. Gray, Michael R. Jaff, Esther S. H. Kim, Pam Mace, Alan H. Matsumoto, Robert D. McBane, Eva Kline-Rogers, Christopher J. White & Heather L. Gornik (2012). "The United States Registry for Fibromuscular Dysplasia: results in the first 447 patients". Circulation. 125 (25): 3182–3190. doi:10.1161/CIRCULATIONAHA.112.091223. PMID 22615343. Unknown parameter
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