Granulomatosis with polyangiitis physical examination
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Differentiating Granulomatosis with polyangiitis from other Diseases |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Ali Poyan Mehr, M.D. [2]Associate Editor(s)-in-Chief: Krzysztof Wierzbicki M.D. [3]
Overview
A complete medical history and a comprehensive renal, pulmonary, and ENT examination must be preformed to help identify and properly diagnose Granulomatosis with polyangiitis from other diseases.
Physical Examination
A thorough physical examination can provide insight into possible causes and associated underlying conditions. The following findings may be present during a physical examination of Granulomatosis with polyangiitis:
- Atelectasis
- Pleural effusion
- Mononeuritis multiplex
- Cranial nerve paralysis
Physical Examination
Vital Signs
- They usually have normal vital signs until infected.
Skin
The skin findings are seen in 14% of patients:[3]
- Ulcerations
- Palpable purpura
- Subcutaneous nodules
HEENT
- Scleritis
- Keratitis
- Uveitis
- Conjunctivitis
- Proptosis
- Xanthelasma
- Purulent exudate from the nares
- Sinusitis
- Saddle nose deformity
- Otitis Media
- Hearing acuity may be reduced[1]
- Weber test may be abnormal
- Rinne test may be positive
- Gingival hyperplasia or necrotizing gingivitis[4] can be seen
Neck
- Neck examination of patients with granulomatosis with polyangiitis is usually normal
Lungs
- 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
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.
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
- Patient is usually oriented to persons, place, and time
- Mononeuritis multiplex- Loss of sensory and motor functions
Extremities
- Extremities examination of patients with [disease name] is usually normal.
References
- ↑ 1.0 1.1 Seo P, Stone JH (July 2004). "The antineutrophil cytoplasmic antibody-associated vasculitides". Am. J. Med. 117 (1): 39–50. doi:10.1016/j.amjmed.2004.02.030. PMID 15210387.
- ↑ Graves N (October 2006). "Wegener granulomatosis". Proc (Bayl Univ Med Cent). 19 (4): 342–4. PMC 1618758. PMID 17106496.
- ↑ Daoud MS, Gibson LE, DeRemee RA, Specks U, el-Azhary RA, Su WP (October 1994). "Cutaneous Wegener's granulomatosis: clinical, histopathologic, and immunopathologic features of thirty patients". J. Am. Acad. Dermatol. 31 (4): 605–12. PMID 8089286.
- ↑ Genuis K, Pewarchuk J (September 2014). "Granulomatosis with polyangiitis (Wegener's) as a necrotizing gingivitis mimic: a case report". J Med Case Rep. 8: 297. doi:10.1186/1752-1947-8-297. PMC 4168997. PMID 25196320.