Sjögren's syndrome physical examination: Difference between revisions

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{{Sjögren's syndrome}}
{{Sjögren's syndrome}}
{{CMG}} {{AE}}
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==Overview==
==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 of patients with is usually remarkable for dryness of all [[mucous membranes]] such as [[mouth]], [[Eye|eyes]], lips, [[anal]] and [[rectal]].
 
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==
* Physical examination of patients with [disease name] is usually normal.
*Physical examination of patients with is usually remarkable for dryness of all [[mucous membranes]] such as [[mouth]], [[Eye|eyes]], lips, [[anal]] and [[rectal]].<ref name="pmid16453296">{{cite journal |vauthors=Lopate G, Pestronk A, Al-Lozi M, Lynch T, Florence J, Miller T, Levine T, Rampy T, Beson B, Ramneantu I |title=Peripheral neuropathy in an outpatient cohort of patients with Sjögren's syndrome |journal=Muscle Nerve |volume=33 |issue=5 |pages=672–6 |date=May 2006 |pmid=16453296 |doi=10.1002/mus.20514 |url=}}</ref><ref name="pmid19254127">{{cite journal |vauthors=Antoniazzi RP, Miranda LA, Zanatta FB, Islabão AG, Gustafsson A, Chiapinotto GA, Oppermann RV |title=Periodontal conditions of individuals with Sjögren's syndrome |journal=J. Periodontol. |volume=80 |issue=3 |pages=429–35 |date=March 2009 |pmid=19254127 |doi=10.1902/jop.2009.080350 |url=}}</ref><ref name="pmid19307256">{{cite journal |vauthors=Riccieri V, Sciarra I, Ceccarelli F, Alessandri C, Croia C, Vasile M, Modesti MG, Priori R, Valesini G |title=Nailfold capillaroscopy abnormalities are associated with the presence of anti-endothelial cell antibodies in Sjogren's syndrome |journal=Rheumatology (Oxford) |volume=48 |issue=6 |pages=704–6 |date=June 2009 |pmid=19307256 |doi=10.1093/rheumatology/kep051 |url=}}</ref><ref name="pmid18085734">{{cite journal |vauthors=Ren H, Wang WM, Chen XN, Zhang W, Pan XX, Wang XL, Lin Y, Zhang S, Chen N |title=Renal involvement and followup of 130 patients with primary Sjögren's syndrome |journal=J. Rheumatol. |volume=35 |issue=2 |pages=278–84 |date=February 2008 |pmid=18085734 |doi= |url=}}</ref><ref name="pmid16397619">{{cite journal |vauthors=Versura P, Frigato M, Cellini M, Mulè R, Malavolta N, Campos EC |title=Diagnostic performance of tear function tests in Sjogren's syndrome patients |journal=Eye (Lond) |volume=21 |issue=2 |pages=229–37 |date=February 2007 |pmid=16397619 |doi=10.1038/sj.eye.6702204 |url=}}</ref><ref name="pmid18599017">{{cite journal |vauthors=Lemp MA |title=Advances in understanding and managing dry eye disease |journal=Am. J. Ophthalmol. |volume=146 |issue=3 |pages=350–356 |date=September 2008 |pmid=18599017 |doi=10.1016/j.ajo.2008.05.016 |url=}}</ref>
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 highly suggestive of [disease name].
 
===Appearance of the Patient===
===Appearance of the Patient===
*Patients with [disease name] usually appear [general appearance].  
*Patients with Sjögren's syndrome usually appear good.


===Vital Signs===
===Vital Signs===
 
*Vital sign might be normal.
*High-grade / 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===
* Skin examination of patients with [disease name] is usually normal.
*Dryness
OR
*[[Scaling skin|Scaling]]
*[[Cyanosis]]  
*Partial or complete loss of [[sweating]]
*[[Jaundice]]
*Dry, sparse, and brittle hair
* [[Pallor]]
*Diffuse [[alopecia]] may involve the [[scalp]], [[Limb (anatomy)|limbs]], [[axilla]], or [[pubis]]
* Bruises
*Nail folds may show capillaroscopic abnormalities
 
*Nonpalpable or palpable, vasculitic [[purpura]], 2-3 mm lesions on the [[Human leg|lower extremities]]
<gallery widths="150px">
*Annular [[erythema]] with scales on the face and neck
 
UploadedImage-01.jpg | Description {{dermref}}
UploadedImage-02.jpg | Description {{dermref}}
 
</gallery>


===HEENT===
===HEENT===
*Mucous dryness
*[[Mucus|Mucous]] dryness
*Red, smooth, and dry tongue
*Red, smooth, and dry [[tongue]]
*Dental caries
*Hyperlobulated [[tongue]] with loss of filiform [[Papilla|papillae]]
*Parotid duct narrowing
*Absence of salivary pooling under the [[tongue]]
*[[Dental caries]]
*[[Gingiva|Gingival]] inflammation
*Red, dry, and scaly lips
*Red, dry, and scaly lips
*Cracks at the corners of the mouth
*Cracks at the corners of the mouth
*Chronic oral candidiasis
*Chronic [[oral]] [[candidiasis]]


===Neck===
===Neck===
* Neck examination of patients with [disease name] is usually normal.
*Bilateral [[parotid gland enlargement]]
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.
*Bibasilar [[rales]]  
OR
* 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
*[[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 Sjögren's syndrome 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.
*[[Splenomegaly]]
 
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 Sjögren's syndrome 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.
*Irritated [[bladder]]
OR
*Suprapubic [[tenderness]]
*A pelvic/adnexal mass may be palpated
*Atrophic changes in the [[vulva]] and [[Vagina|vagin]]
*Inflamed mucosa
*Dryness of the [[anal]] and [[rectal]] [[mucous membranes]]
*Clear/(color), foul-smelling/odorless penile/vaginal discharge


===Neuromuscular===
===Neuromuscular===
* Neuromuscular examination of patients with [disease name] is usually normal.
*Patient is usually oriented to persons, place, and time.
OR
*Glasgow coma scale is 15/15
*Patient is usually oriented to persons, place, and time
*[[Paraparesis]] maybe present  
* Altered mental status
*[[Paraplegia]] may be present
* 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===
* Extremities examination of patients with [disease name] is usually normal.
*Symmetrical, polyarticular, [[inflammatory arthritis]]
OR
*[[Clubbing]]
*[[Cyanosis]]
*Pitting/non-pitting [[edema]] of the upper/lower extremities
*Muscle atrophy
*Fasciculations in the upper/lower extremity
 


==References==
==References==
{{reflist|2}}
{{reflist|2}}


[[Category:Medicine]]
[[Category:Immunology]]
[[Category:Rheumatology]]
[[Category:Rheumatology]]
[[Category:Immunology]]
[[Category:Up-To-Date]]
 
{{WS}}
{{WH}}

Latest revision as of 00:12, 30 July 2020

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

Overview

Physical examination of patients with is usually remarkable for dryness of all mucous membranes such as mouth, eyes, lips, anal and rectal.

Physical Examination

Appearance of the Patient

  • Patients with Sjögren's syndrome usually appear good.

Vital Signs

  • Vital sign might be normal.

Skin

HEENT

Neck

Lungs

Heart

  • Cardiovascular examination of patients with Sjögren's syndrome is usually normal.

Abdomen

Back

  • Back examination of patients with Sjögren's syndrome is usually normal.

Genitourinary

Neuromuscular

  • Patient is usually oriented to persons, place, and time.
  • Glasgow coma scale is 15/15
  • Paraparesis maybe present
  • Paraplegia may be present

Extremities

References

  1. ↑ Lopate G, Pestronk A, Al-Lozi M, Lynch T, Florence J, Miller T, Levine T, Rampy T, Beson B, Ramneantu I (May 2006). "Peripheral neuropathy in an outpatient cohort of patients with Sjögren's syndrome". Muscle Nerve. 33 (5): 672–6. doi:10.1002/mus.20514. PMID 16453296.
  2. ↑ Antoniazzi RP, Miranda LA, Zanatta FB, Islabão AG, Gustafsson A, Chiapinotto GA, Oppermann RV (March 2009). "Periodontal conditions of individuals with Sjögren's syndrome". J. Periodontol. 80 (3): 429–35. doi:10.1902/jop.2009.080350. PMID 19254127.
  3. ↑ Riccieri V, Sciarra I, Ceccarelli F, Alessandri C, Croia C, Vasile M, Modesti MG, Priori R, Valesini G (June 2009). "Nailfold capillaroscopy abnormalities are associated with the presence of anti-endothelial cell antibodies in Sjogren's syndrome". Rheumatology (Oxford). 48 (6): 704–6. doi:10.1093/rheumatology/kep051. PMID 19307256.
  4. ↑ Ren H, Wang WM, Chen XN, Zhang W, Pan XX, Wang XL, Lin Y, Zhang S, Chen N (February 2008). "Renal involvement and followup of 130 patients with primary Sjögren's syndrome". J. Rheumatol. 35 (2): 278–84. PMID 18085734.
  5. ↑ Versura P, Frigato M, Cellini M, Mulè R, Malavolta N, Campos EC (February 2007). "Diagnostic performance of tear function tests in Sjogren's syndrome patients". Eye (Lond). 21 (2): 229–37. doi:10.1038/sj.eye.6702204. PMID 16397619.
  6. ↑ Lemp MA (September 2008). "Advances in understanding and managing dry eye disease". Am. J. Ophthalmol. 146 (3): 350–356. doi:10.1016/j.ajo.2008.05.016. PMID 18599017.
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