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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].
Patients with temporal arteritis usually appear in [[pain]] or normal. The presence of temporal tenderness on physical examination is highly suggestive of temporal arteritis. [[Ophthalmoscope|Ophthalmoscopic exam]] may be abnormal with findings of sludging of blood in [[Retinal artery|retinal arterioles]], [[optic disc]] may show chalky white [[pallor]] and [[edema]], with or without [[Splinter hemorrhage|splinter hemorrhages]], [[Posterior ischemic optic neuropathy|posterior ischemic (retrobulbar) optic neuropathy]], [[Central retinal artery|central retinal artery occlusion]], branch of [[Central retinal artery|retinal artery]] occlusion, and [[Choroid|choroidal]] [[ischemia]]. [[Tenderness]] upon palpation of the temporal region including [[erythema]], nodularity, and thickening on affected side. Other findings include facial [[tenderness]], [[diplopia]], [[ptosis]], [[nystagmus]], [[Internuclear ophthalmoplegia|internuclear ophthalmoplegia (INO)]], and [[Pupil|pupillary]] abnormalities.
 
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.
*The presence of temporal tenderness on physical examination is highly suggestive of temporal arteritis.
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 temporal arteritis usually appear in [[pain]].  


===Vital Signs===
===Vital Signs===
 
*Vital signs are with in normal limits.
*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.
* Skin examination of patients with temporal is usually normal.
OR
*[[Cyanosis]]
*[[Jaundice]]
* [[Pallor]]
* Bruises
 
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===HEENT===
===HEENT===
* HEENT examination of patients with [disease name] is usually normal.
*[[Ophthalmoscope|Ophthalmoscopic]] exam may be abnormal with findings of sludging of [[blood]] in [[retinal]] [[Arteriole|arterioles]], [[optic disc]] may show chalky white [[pallor]] and [[edema]], with or without [[Splinter hemorrhage|splinter hemorrhages]], [[Posterior ischemic optic neuropathy|posterior ischemic (retrobulbar) optic]] neuropathy, [[central retinal artery]] [[occlusion]], branch of [[Central retinal artery|retinal artery]] [[occlusion]], and [[Choroid|choroidal]] [[ischemia]]<ref name="SahaRehman2005">{{cite journal|last1=Saha|first1=N|last2=Rehman|first2=S U|title=Reversal of chronic ocular ischaemia with good visual recovery in giant cell arteritis|journal=Eye|volume=20|issue=6|year=2005|pages=742–743|issn=0950-222X|doi=10.1038/sj.eye.6701998}}</ref><ref name="pmid11130757">{{cite journal| author=Schäuble B, Wijman CA, Koleini B, Babikian VL| title=Ophthalmic artery microembolism in giant cell arteritis. | journal=J Neuroophthalmol | year= 2000 | volume= 20 | issue= 4 | pages= 273-5 | pmid=11130757 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11130757  }} </ref><ref name="pmid16033712">{{cite journal| author=Schmidt D| title=Ocular ichemia syndrome - a malignant course of giant cell arteritis. | journal=Eur J Med Res | year= 2005 | volume= 10 | issue= 6 | pages= 233-42 | pmid=16033712 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16033712  }} </ref><ref name="pmid10387340">{{cite journal| author=Tovilla-Canales JL| title=Ocular manifestations of giant cell arteritis. | journal=Curr Opin Ophthalmol | year= 1998 | volume= 9 | issue= 6 | pages= 73-9 | pmid=10387340 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10387340  }} </ref><ref name="pmid12972779">{{cite journal| author=Al-Abdulla NA, Kelley JS, Green WR, Miller NR| title=Herpes zoster vasculitis presenting as giant cell arteritis with choroidal infarction. | journal=Retina | year= 2003 | volume= 23 | issue= 4 | pages= 567-9 | pmid=12972779 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12972779  }} </ref><ref name="pmid11177002">{{cite journal| author=Casson RJ, Fleming FK, Shaikh A, James B| title=Bilateral ocular ischemic syndrome secondary to giant cell arteritis. | journal=Arch Ophthalmol | year= 2001 | volume= 119 | issue= 2 | pages= 306-7 | pmid=11177002 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11177002  }} </ref>
OR
*[[Tenderness]] upon [[palpation]] of the [[temporal]] region including [[erythema]], nodularity, and thickening on affected side
* Abnormalities of the head/hair may include ___
*[[Facial]] [[tenderness]]
* Evidence of trauma
*Neuro-[[Ophthalmic artery|ophthalmic]] manifestations of temporal arteritis include the following:<ref name="pmid18606086">{{cite journal| author=Borg FA, Salter VL, Dasgupta B| title=Neuro-ophthalmic complications in giant cell arteritis. | journal=Curr Allergy Asthma Rep | year= 2008 | volume= 8 | issue= 4 | pages= 323-30 | pmid=18606086 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18606086  }} </ref>
* Icteric sclera
**[[Diplopia]]
* [[Nystagmus]]  
**[[Ptosis]]<ref name="pmid11203169">{{cite journal| author=Killer HE, Holtz DJ, Kaiser HJ, Laeng RH| title=Diplopia, ptosis, and hepatitis as presenting signs and symptoms of giant cell arteritis. | journal=Br J Ophthalmol | year= 2000 | volume= 84 | issue= 11 | pages= 1319-20 | pmid=11203169 | doi= | pmc=1723314 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11203169  }} </ref>
* Extra-ocular movements may be abnormal
**[[Nystagmus]]
*Pupils non-reactive to light / non-reactive to accommodation / non-reactive to neither light nor accommodation
**[[Internuclear ophthalmoplegia|Internuclear ophthalmoplegia (INO)]]<ref name="pmid10366177">{{cite journal| author=Ahmad I, Zaman M| title=Bilateral internuclear ophthalmoplegia: an initial presenting sign of giant cell arteritis. | journal=J Am Geriatr Soc | year= 1999 | volume= 47 | issue= 6 | pages= 734-6 | pmid=10366177 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10366177  }} </ref>
*Ophthalmoscopic exam may be abnormal with findings of ___
**[[Pupil|Pupillary]] abnormalities<ref name="pmid12642330">{{cite journal| author=Foroozan R, Buono LM, Savino PJ, Sergott RC| title=Tonic pupils from giant cell arteritis. | journal=Br J Ophthalmol | year= 2003 | volume= 87 | issue= 4 | pages= 510-2 | pmid=12642330 | doi= | pmc=1771609 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12642330  }} </ref>
* 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===
* Neck examination of patients with [disease name] is usually normal.
* Neck examination of patients with temporal arteritis 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===
===Lungs===
* Pulmonary examination of patients with [disease name] is usually normal.
* Pulmonary examination of patients with temporal arteritis 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
*[[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 temporal arteritis 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 temporal arteritis 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===
* Back examination of patients with [disease name] is usually normal.
* Back examination of patients with temporal arteritis 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 temporal arteritis is usually normal.
OR
*A pelvic/adnexal mass may be palpated
*Inflamed mucosa
*Clear/(color), foul-smelling/odorless penile/vaginal discharge


===Neuromuscular===
===Neuromuscular===
* Neuromuscular examination of patients with [disease name] is usually normal.
* Neuromuscular examination of patients with temporal arteritis 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===
* Extremities examination of patients with [disease name] is usually normal.
* Extremities examination of patients with temporal arteritis 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==
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[[Category:Emergency medicine]]
[[Category:Emergency medicine]]
[[Category:Disease]]
[[Category:Disease]]
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Latest revision as of 19:14, 16 April 2018

Temporal Arteritis Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Hamid Qazi, MD, BSc [2]

Overview

Patients with temporal arteritis usually appear in pain or normal. The presence of temporal tenderness on physical examination is highly suggestive of temporal arteritis. Ophthalmoscopic exam may be abnormal with findings of sludging of blood in retinal arterioles, optic disc may show chalky white pallor and edema, with or without splinter hemorrhages, posterior ischemic (retrobulbar) optic neuropathy, central retinal artery occlusion, branch of retinal artery occlusion, and choroidal ischemia. Tenderness upon palpation of the temporal region including erythema, nodularity, and thickening on affected side. Other findings include facial tenderness, diplopia, ptosis, nystagmus, internuclear ophthalmoplegia (INO), and pupillary abnormalities.

Physical Examination

  • The presence of temporal tenderness on physical examination is highly suggestive of temporal arteritis.

Appearance of the Patient

  • Patients with temporal arteritis usually appear in pain.

Vital Signs

  • Vital signs are with in normal limits.

Skin

  • Skin examination of patients with temporal is usually normal.

HEENT

Neck

  • Neck examination of patients with temporal arteritis is usually normal.

Lungs

  • Pulmonary examination of patients with temporal arteritis is usually normal.

Heart

  • Cardiovascular examination of patients with temporal arteritis is usually normal.

Abdomen

Abdominal examination of patients with temporal arteritis is usually normal.

Back

  • Back examination of patients with temporal arteritis is usually normal.

Genitourinary

  • Genitourinary examination of patients with temporal arteritis is usually normal.

Neuromuscular

  • Neuromuscular examination of patients with temporal arteritis is usually normal.

Extremities

  • Extremities examination of patients with temporal arteritis is usually normal.

References

  1. ↑ Saha, N; Rehman, S U (2005). "Reversal of chronic ocular ischaemia with good visual recovery in giant cell arteritis". Eye. 20 (6): 742–743. doi:10.1038/sj.eye.6701998. ISSN 0950-222X.
  2. ↑ Schäuble B, Wijman CA, Koleini B, Babikian VL (2000). "Ophthalmic artery microembolism in giant cell arteritis". J Neuroophthalmol. 20 (4): 273–5. PMID 11130757.
  3. ↑ Schmidt D (2005). "Ocular ichemia syndrome - a malignant course of giant cell arteritis". Eur J Med Res. 10 (6): 233–42. PMID 16033712.
  4. ↑ Tovilla-Canales JL (1998). "Ocular manifestations of giant cell arteritis". Curr Opin Ophthalmol. 9 (6): 73–9. PMID 10387340.
  5. ↑ Al-Abdulla NA, Kelley JS, Green WR, Miller NR (2003). "Herpes zoster vasculitis presenting as giant cell arteritis with choroidal infarction". Retina. 23 (4): 567–9. PMID 12972779.
  6. ↑ Casson RJ, Fleming FK, Shaikh A, James B (2001). "Bilateral ocular ischemic syndrome secondary to giant cell arteritis". Arch Ophthalmol. 119 (2): 306–7. PMID 11177002.
  7. ↑ Borg FA, Salter VL, Dasgupta B (2008). "Neuro-ophthalmic complications in giant cell arteritis". Curr Allergy Asthma Rep. 8 (4): 323–30. PMID 18606086.
  8. ↑ Killer HE, Holtz DJ, Kaiser HJ, Laeng RH (2000). "Diplopia, ptosis, and hepatitis as presenting signs and symptoms of giant cell arteritis". Br J Ophthalmol. 84 (11): 1319–20. PMC 1723314. PMID 11203169.
  9. ↑ Ahmad I, Zaman M (1999). "Bilateral internuclear ophthalmoplegia: an initial presenting sign of giant cell arteritis". J Am Geriatr Soc. 47 (6): 734–6. PMID 10366177.
  10. ↑ Foroozan R, Buono LM, Savino PJ, Sergott RC (2003). "Tonic pupils from giant cell arteritis". Br J Ophthalmol. 87 (4): 510–2. PMC 1771609. PMID 12642330.

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