Mixed connective tissue disease physical examination: Difference between revisions

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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 MCTD is usually remarkable by clinical features seen in [[Systemic lupus erythematosus|systemic lupus erythematosus (SLE)]], [[Rheumatoid arthritis|rheumatoid arthritis (RA)]], [[Dermatomyositis|dermatomyositis (DM)]], [[polymyositis]], and [[scleroderma]]. Physical examination in patients with MCTD include [[tachycardia]], [[tachypnea]], periungual [[telangiectasia]], [[sclerodactyly]], [[Jugular venous pressure|jugular vein distention]], [[rhonchi]] and [[Wheeze|wheezing]], [[joint swelling]] and [[tenderness]], and joints [[erythema]].
 
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 MCTD is usually remarkable by clinical features seen in [[Systemic lupus erythematosus|systemic lupus erythematosus (SLE)]], [[Rheumatoid arthritis|rheumatoid arthritis (RA)]], [[Dermatomyositis|dermatomyositis (DM)]], [[polymyositis]], and [[scleroderma]].
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].
* Patient appears well in the earlier stages of the disease
 
* Patient appears ill in the late stages of the disease due to multi-organ involvement
===Vital Signs===
 
*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===
===Vital Signs<ref name="pmid15716315">{{cite journal |vauthors=Bodolay E, Szekanecz Z, Dévényi K, Galuska L, Csípo I, Vègh J, Garai I, Szegedi G |title=Evaluation of interstitial lung disease in mixed connective tissue disease (MCTD) |journal=Rheumatology (Oxford) |volume=44 |issue=5 |pages=656–61 |date=May 2005 |pmid=15716315 |doi=10.1093/rheumatology/keh575 |url=}}</ref>===
* Skin examination of patients with [disease name] is usually normal.
OR
*[[Cyanosis]]
*[[Jaundice]]
* [[Pallor]]
* Bruises


<gallery widths="150px">
*[[Tachycardia]]
*[[Tachypnea]]


UploadedImage-01.jpg | Description {{dermref}}
===Skin<ref name="pmid23756459">{{cite journal |vauthors=Dabiri G, Falanga V |title=Connective tissue ulcers |journal=J Tissue Viability |volume=22 |issue=4 |pages=92–102 |date=November 2013 |pmid=23756459 |pmc=3930159 |doi=10.1016/j.jtv.2013.04.003 |url=}}</ref><ref name="pmid7385833">{{cite journal |vauthors=Prystowsky SD |title=Mixed connective tissue disease |journal=West. J. Med. |volume=132 |issue=4 |pages=288–93 |date=April 1980 |pmid=7385833 |pmc=1272064 |doi= |url=}}</ref>===
UploadedImage-02.jpg | Description {{dermref}}
* [[Calcinosis]]
 
* [[Telangiectasia]]
</gallery>
* [[Malar rash]] 
* Periungual [[Telangiectasia|telangiectasias]] and [[erythema]] may be present
* Skin may be pale (secondary to [[anemia]])
* [[Sclerodactyly]]
* Skin [[Ulcerations|ulceration]]


===HEENT===
===HEENT===
* HEENT examination of patients with [disease name] is usually normal.
* HEENT examination of patients with mixed connective tissue disease is usually normal.
OR
===Neck<ref name="pmid24353496">{{cite journal |vauthors=Latuśkiewicz-Potemska J, Zygmunt A, Biernacka-Zielińska M, Stańczyk J, Smolewska E |title=Mixed connective tissue disease presenting with progressive scleroderma symptoms in a 10-year-old girl |journal=Postepy Dermatol Alergol |volume=30 |issue=5 |pages=329–36 |date=October 2013 |pmid=24353496 |pmc=3858664 |doi=10.5114/pdia.2013.38365 |url=}}</ref>===
* Abnormalities of the head/hair may include ___
* [[Lymphadenopathy]]  
* Evidence of trauma
* [[Jugular venous distension]] (suggests [[pulmonary hypertension]])
* Icteric sclera
===Lungs<ref name="pmid15716315">{{cite journal |vauthors=Bodolay E, Szekanecz Z, Dévényi K, Galuska L, Csípo I, Vègh J, Garai I, Szegedi G |title=Evaluation of interstitial lung disease in mixed connective tissue disease (MCTD) |journal=Rheumatology (Oxford) |volume=44 |issue=5 |pages=656–61 |date=May 2005 |pmid=15716315 |doi=10.1093/rheumatology/keh575 |url=}}</ref>===
* [[Nystagmus]]
* Bibasilar [[Rales|crackles]]
* Extra-ocular movements may be abnormal
*[[Rhonchi]]
*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 / 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 mixed connective tissue disease 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.
* Abdominal examination of patients with mixed connective tissue disease 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===
* Genitourinary examination of patients with [disease name] is usually normal.
* Genitourinary examination of patients with mixed connective tissue disease is usually normal.
OR
===Extremities<ref name="pmid718271">{{cite journal |vauthors=Bennett RM, O'Connell DJ |title=The arthritis of mixed connective tissue disease |journal=Ann. Rheum. Dis. |volume=37 |issue=5 |pages=397–403 |date=October 1978 |pmid=718271 |pmc=1000265 |doi= |url=}}</ref><ref name="pmid758918">{{cite journal |vauthors=Ramos-Niembro F, Alarcón-Segovia D, Hernández-Ortíz J |title=Articular manifestations of mixed connective tissue disease |journal=Arthritis Rheum. |volume=22 |issue=1 |pages=43–51 |date=January 1979 |pmid=758918 |doi= |url=}}</ref><ref name="pmid24470658">{{cite journal |vauthors=Sen S, Sinhamahapatra P, Choudhury S, Gangopadhyay A, Bala S, Sircar G, Chatterjee G, Ghosh A |title=Cutaneous manifestations of mixed connective tissue disease: study from a tertiary care hospital in eastern India |journal=Indian J Dermatol |volume=59 |issue=1 |pages=35–40 |date=January 2014 |pmid=24470658 |pmc=3884926 |doi=10.4103/0019-5154.123491 |url=}}</ref>===
*A pelvic/adnexal mass may be palpated
*[[Joint swelling]] and [[tenderness]] (features of [[rheumatologic disease]])
*Inflamed mucosa
*Edema of the hands
*Clear/(color), foul-smelling/odorless penile/vaginal discharge
* [[Arthritis]]
 
** Symmetric and polyarticular
===Neuromuscular===
** Majority of times involves knees, carpal [[Joint|joints]], and [[Joint|joints]] of the fingers (especially the proximal [[interphalangeal]] (PIP) [[joint]] and metacarpophalangeal (MCP) joint)
* Neuromuscular examination of patients with [disease name] is usually normal.
** Decrease [[range of motion]]
OR
* Joints [[erythema]] (due to [[synovitis]])
*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.
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}}
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[[Category:Medicine]]
[[Category:Up-To-Date]]
[[Category:Rheumatology]]

Latest revision as of 16:19, 4 May 2018

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

Overview

Physical examination of patients with MCTD is usually remarkable by clinical features seen in systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), dermatomyositis (DM), polymyositis, and scleroderma. Physical examination in patients with MCTD include tachycardia, tachypnea, periungual telangiectasia, sclerodactyly, jugular vein distention, rhonchi and wheezing, joint swelling and tenderness, and joints erythema.

Physical Examination

Appearance of the Patient

  • Patient appears well in the earlier stages of the disease
  • Patient appears ill in the late stages of the disease due to multi-organ involvement

Vital Signs[1]

Skin[2][3]

HEENT

  • HEENT examination of patients with mixed connective tissue disease is usually normal.

Neck[4]

Lungs[1]

Heart

  • Cardiovascular examination of patients with mixed connective tissue disease is usually normal.

Abdomen

  • Abdominal examination of patients with mixed connective tissue disease is usually normal.

Genitourinary

  • Genitourinary examination of patients with mixed connective tissue disease is usually normal.

Extremities[5][6][7]

References

  1. ↑ 1.0 1.1 Bodolay E, Szekanecz Z, Dévényi K, Galuska L, Csípo I, Vègh J, Garai I, Szegedi G (May 2005). "Evaluation of interstitial lung disease in mixed connective tissue disease (MCTD)". Rheumatology (Oxford). 44 (5): 656–61. doi:10.1093/rheumatology/keh575. PMID 15716315.
  2. ↑ Dabiri G, Falanga V (November 2013). "Connective tissue ulcers". J Tissue Viability. 22 (4): 92–102. doi:10.1016/j.jtv.2013.04.003. PMC 3930159. PMID 23756459.
  3. ↑ Prystowsky SD (April 1980). "Mixed connective tissue disease". West. J. Med. 132 (4): 288–93. PMC 1272064. PMID 7385833.
  4. ↑ Latuśkiewicz-Potemska J, Zygmunt A, Biernacka-Zielińska M, Stańczyk J, Smolewska E (October 2013). "Mixed connective tissue disease presenting with progressive scleroderma symptoms in a 10-year-old girl". Postepy Dermatol Alergol. 30 (5): 329–36. doi:10.5114/pdia.2013.38365. PMC 3858664. PMID 24353496.
  5. ↑ Bennett RM, O'Connell DJ (October 1978). "The arthritis of mixed connective tissue disease". Ann. Rheum. Dis. 37 (5): 397–403. PMC 1000265. PMID 718271.
  6. ↑ Ramos-Niembro F, Alarcón-Segovia D, Hernández-Ortíz J (January 1979). "Articular manifestations of mixed connective tissue disease". Arthritis Rheum. 22 (1): 43–51. PMID 758918.
  7. ↑ Sen S, Sinhamahapatra P, Choudhury S, Gangopadhyay A, Bala S, Sircar G, Chatterjee G, Ghosh A (January 2014). "Cutaneous manifestations of mixed connective tissue disease: study from a tertiary care hospital in eastern India". Indian J Dermatol. 59 (1): 35–40. doi:10.4103/0019-5154.123491. PMC 3884926. PMID 24470658.

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