Familial mediterranean fever physical examination: Difference between revisions
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Common physical examination findings of familial Mediterranean fever include fever, arthritis, and skin rash. | Common physical examination findings of familial Mediterranean fever include fever, arthritis, and skin rash. | ||
==Physical Examination== | ==Physical Examination== | ||
*Physical examination of patients with familial Mediterranean fever in periods between attacks is usually normal. | *Physical examination of patients with [[familial Mediterranean fever]] in periods between attacks is usually normal.<ref name="pmid26316943">{{cite journal |vauthors=Flynn AE, Peters MJ, Morgan LC |title=Attitudes towards Lung Cancer Screening in an Australian High-Risk Population |journal=Lung Cancer Int |volume=2013 |issue= |pages=789057 |date=2013 |pmid=26316943 |doi=10.1155/2013/789057 |url= |issn=}}</ref> | ||
*During attacks, common physical examination findings include fever, arthritis, and skin rash. | *During attacks, common physical examination findings include [[fever]], [[arthritis]], and [[skin rash]]. | ||
*Tachypnea and tachycardia may be present due to the effect of fever. | *[[Tachypnea]] and [[tachycardia]] may be present due to the effect of [[fever]]. | ||
*[[Fever]] is usually short lasting (12-72 h) with a wide frequency ranging from weekly intervals to every season or more. | |||
===Skin=== | ===Skin=== | ||
* Skin examination of patients with familial Mediterranean fever is usually normal. However, non-specific skin lesions may also be present. | * Skin examination of patients with familial Mediterranean fever is usually normal. However, non-specific skin lesions may also be present. | ||
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*[[Lymphadenopathy]] which may be with/without pain | *[[Lymphadenopathy]] which may be with/without pain | ||
===Lungs=== | ===Lungs=== | ||
* Pulmonary examination of patients with familial Mediterranean fever may be positive for: | * Pulmonary examination of patients with familial Mediterranean fever may be positive for:<ref name="pmid26316943">{{cite journal |vauthors=Flynn AE, Peters MJ, Morgan LC |title=Attitudes towards Lung Cancer Screening in an Australian High-Risk Population |journal=Lung Cancer Int |volume=2013 |issue= |pages=789057 |date=2013 |pmid=26316943 |doi=10.1155/2013/789057 |url= |issn=}}</ref> | ||
*Lungs are hyporesonant due to associated pleural effusion | *Lungs are hyporesonant due to associated pleural effusion | ||
*Normal/reduced [[tactile fremitus]] | *Normal/reduced [[tactile fremitus]] | ||
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*[[Friction rub]] | *[[Friction rub]] | ||
===Abdomen=== | ===Abdomen=== | ||
* Abdominal examination of patients with familial Mediterranean fever | * Abdominal examination of patients with familial Mediterranean fever may show rigidity and tenderness.<ref name="pmid17240429">{{cite journal |vauthors=Berkun Y, Ben-Chetrit E, Klar A, Ben-Chetrit E |title=Peritoneal adhesions and intestinal obstructions in patients with familial Mediterranean fever--are they more frequent? |journal=Semin. Arthritis Rheum. |volume=36 |issue=5 |pages=316–21 |date=April 2007 |pmid=17240429 |doi=10.1016/j.semarthrit.2006.11.002 |url=}}</ref> | ||
*[[Hepatomegaly]] / [[splenomegaly]] / [[hepatosplenomegaly]] may be present. | * [[Hepatomegaly]] / [[splenomegaly]] / [[hepatosplenomegaly]] may also be present. | ||
* Other possible causes of an acute abdomen should be ruled out. | |||
===Back=== | ===Back=== | ||
* Back examination of patients with familial Mediterranean fever is usually normal. | * Back examination of patients with familial Mediterranean fever is usually normal. | ||
* Signs of sacroileitis such may be present.<ref name="pmid9093587">{{cite journal |vauthors=Majeed HA, Rawashdeh M |title=The clinical patterns of arthritis in children with familial Mediterranean fever |journal=QJM |volume=90 |issue=1 |pages=37–43 |date=January 1997 |pmid=9093587 |doi=10.1093/qjmed/90.1.37 |url=}}</ref><ref name="pmid18795391">{{cite journal |vauthors=Kaşifoğlu T, Calişir C, Cansu DU, Korkmaz C |title=The frequency of sacroiliitis in familial Mediterranean fever and the role of HLA-B27 and MEFV mutations in the development of sacroiliitis |journal=Clin. Rheumatol. |volume=28 |issue=1 |pages=41–6 |date=January 2009 |pmid=18795391 |doi=10.1007/s10067-008-0980-3 |url=}}</ref> | |||
===Genitourinary=== | ===Genitourinary=== | ||
* Genitourinary examination of patients with familial Mediterranean fever is usually normal. | * Genitourinary examination of patients with familial Mediterranean fever is usually normal. | ||
* Scrotal swelling may be seen in case of acute scrotum due to FMF, which rarely involves both testicles.<ref name="pmid1456246">{{cite journal |vauthors=Gedalia A, Mordehai J, Mares AJ |title=Acute scrotal involvement in children with familial Mediterranean fever |journal=Am. J. Dis. Child. |volume=146 |issue=12 |pages=1419–20 |date=December 1992 |pmid=1456246 |doi= |url=}}</ref><ref name="pmid10663841">{{cite journal |vauthors=Majeed HA, Ghandour K, Shahin HM |title=The acute scrotum in Arab children with familial Mediterranean fever |journal=Pediatr. Surg. Int. |volume=16 |issue=1-2 |pages=72–4 |date=2000 |pmid=10663841 |doi= |url=}}</ref><ref name="pmid8044614">{{cite journal |vauthors=Eshel G, Vinograd I, Barr J, Zemer D |title=Acute scrotal pain complicating familial Mediterranean fever in children |journal=Br J Surg |volume=81 |issue=6 |pages=894–6 |date=June 1994 |pmid=8044614 |doi= |url=}}</ref> | |||
* Testicular torsion must always be ruled out. | |||
===Neuromuscular=== | ===Neuromuscular=== | ||
* Neuromuscular examination of patients with familial Mediterranean fever is usually normal. | * Neuromuscular examination of patients with familial Mediterranean fever is usually normal. | ||
*Patient is usually oriented to persons, place, and time. | * Patient is usually oriented to persons, place, and time. | ||
*Neuropathy may also be present. | * Neuropathy may also be present. | ||
===Extremities=== | ===Extremities=== | ||
* | * FMF usually affects large joints of lower extremity and signs of inflammation may be present.<ref name="pmid9093587">{{cite journal |vauthors=Majeed HA, Rawashdeh M |title=The clinical patterns of arthritis in children with familial Mediterranean fever |journal=QJM |volume=90 |issue=1 |pages=37–43 |date=January 1997 |pmid=9093587 |doi=10.1093/qjmed/90.1.37 |url=}}</ref> | ||
* The small joints of the hands can also be involved. | |||
==References== | ==References== | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sahar Memar Montazerin, M.D.[2]
Overview
Common physical examination findings of familial Mediterranean fever include fever, arthritis, and skin rash.
Physical Examination
- Physical examination of patients with familial Mediterranean fever in periods between attacks is usually normal.[1]
- During attacks, common physical examination findings include fever, arthritis, and skin rash.
- Tachypnea and tachycardia may be present due to the effect of fever.
- Fever is usually short lasting (12-72 h) with a wide frequency ranging from weekly intervals to every season or more.
Skin
- Skin examination of patients with familial Mediterranean fever is usually normal. However, non-specific skin lesions may also be present.
- Potential skin lesions include:
HEENT
- HEENT examination of patients with familial Mediterranean fever is usually normal. However, it may also be positive for findings such as:
- Ophthalmoscopic exam may be abnormal with findings of erythematous conjunctivae
- Hearing acuity may be reduced
- Weber test may be abnormal
- Rinne test may be positive
- Exudate from the ear canal
- Erythematous throat with/without tonsillar swelling, and exudates
Neck
- Neck examination of patients with familial Mediterranean fever is usually normal. However, it may also indicate findings such as:
- Lymphadenopathy which may be with/without pain
Lungs
- Pulmonary examination of patients with familial Mediterranean fever may be positive for:[1]
- Lungs are hyporesonant due to associated pleural effusion
- Normal/reduced tactile fremitus
Heart
- Cardiovascular examination of patients with familial Mediterranean fever may be associated with the following findings:
- Chest tenderness upon palpation due to pericarditis
- Friction rub
Abdomen
- Abdominal examination of patients with familial Mediterranean fever may show rigidity and tenderness.[2]
- Hepatomegaly / splenomegaly / hepatosplenomegaly may also be present.
- Other possible causes of an acute abdomen should be ruled out.
Back
- Back examination of patients with familial Mediterranean fever is usually normal.
- Signs of sacroileitis such may be present.[3][4]
Genitourinary
- Genitourinary examination of patients with familial Mediterranean fever is usually normal.
- Scrotal swelling may be seen in case of acute scrotum due to FMF, which rarely involves both testicles.[5][6][7]
- Testicular torsion must always be ruled out.
Neuromuscular
- Neuromuscular examination of patients with familial Mediterranean fever is usually normal.
- Patient is usually oriented to persons, place, and time.
- Neuropathy may also be present.
Extremities
- FMF usually affects large joints of lower extremity and signs of inflammation may be present.[3]
- The small joints of the hands can also be involved.
References
- ↑ 1.0 1.1 Flynn AE, Peters MJ, Morgan LC (2013). "Attitudes towards Lung Cancer Screening in an Australian High-Risk Population". Lung Cancer Int. 2013: 789057. doi:10.1155/2013/789057. PMID 26316943.
- ↑ Berkun Y, Ben-Chetrit E, Klar A, Ben-Chetrit E (April 2007). "Peritoneal adhesions and intestinal obstructions in patients with familial Mediterranean fever--are they more frequent?". Semin. Arthritis Rheum. 36 (5): 316–21. doi:10.1016/j.semarthrit.2006.11.002. PMID 17240429.
- ↑ 3.0 3.1 Majeed HA, Rawashdeh M (January 1997). "The clinical patterns of arthritis in children with familial Mediterranean fever". QJM. 90 (1): 37–43. doi:10.1093/qjmed/90.1.37. PMID 9093587.
- ↑ Kaşifoğlu T, Calişir C, Cansu DU, Korkmaz C (January 2009). "The frequency of sacroiliitis in familial Mediterranean fever and the role of HLA-B27 and MEFV mutations in the development of sacroiliitis". Clin. Rheumatol. 28 (1): 41–6. doi:10.1007/s10067-008-0980-3. PMID 18795391.
- ↑ Gedalia A, Mordehai J, Mares AJ (December 1992). "Acute scrotal involvement in children with familial Mediterranean fever". Am. J. Dis. Child. 146 (12): 1419–20. PMID 1456246.
- ↑ Majeed HA, Ghandour K, Shahin HM (2000). "The acute scrotum in Arab children with familial Mediterranean fever". Pediatr. Surg. Int. 16 (1–2): 72–4. PMID 10663841.
- ↑ Eshel G, Vinograd I, Barr J, Zemer D (June 1994). "Acute scrotal pain complicating familial Mediterranean fever in children". Br J Surg. 81 (6): 894–6. PMID 8044614.