Churg-Strauss syndrome physical examination: Difference between revisions
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==Overview== | ==Overview== | ||
A comprehensive physical examination including [[Lung|pulmonary]], ENT, [[Nervous system|neurologic]], [[skin]], [[Abdomen|abdominal]] and [[Kidney|renal]] systems must be performed to help identify and properly diagnose [[eosinophilic granulomatosis with polyangiitis]] form other diseases. On examination, patients may show clinical manifestations of [[asthma]] ([[dyspnea]], [[tachypnea]]), [[Petechia|petechiae]], palpable [[purpura]], skin nodules, [[rhinitis]], [[Nasal polyp|nasal polyposis]], [[chest pain]], [[abdominal pain]], and neurologic manifestations. On auscultation, [[Wheeze|wheezing]], [[rhonchi]], [[Pericardial friction rub|friction rub]], abnormal heart sounds may be found. | |||
==Physical Examination== | |||
Physical examination findings of patients with [[eosinophilic granulomatosis with polyangiitis]] depends on organ system involvement. 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 [[eosinophilic granulomatosis with polyangiitis]]. | |||
===Appearance of the Patient=== | ===Appearance of the Patient=== | ||
*Patients with [ | *Patients with [[eosinophilic granulomatosis with polyangiitis]] usually appear ill. | ||
===Vital Signs=== | ===Vital Signs=== | ||
* [[Fever]] | |||
* [[Tachypnea]] | |||
*[[ | * [[Dyspnea]] | ||
*[[ | * [[Hypertension]] | ||
*[[ | |||
* | |||
===Skin=== | ===Skin=== | ||
* Skin examination of patients with [ | *Skin examination of patients with [[eosinophilic granulomatosis with polyangiitis]] may show:<ref name="pmid9270504">{{cite journal |vauthors=Davis MD, Daoud MS, McEvoy MT, Su WP |title=Cutaneous manifestations of Churg-Strauss syndrome: a clinicopathologic correlation |journal=J. Am. Acad. Dermatol. |volume=37 |issue=2 Pt 1 |pages=199–203 |date=August 1997 |pmid=9270504 |doi= |url=}}</ref> | ||
**[[Petechia|Petechiae]] | |||
*[[ | **[[Bruise|Ecchymosis]] | ||
*[[ | **[[Urticaria|Urticarial rash]] | ||
* [[ | **[[Purpura]] | ||
* | **Nodules | ||
===HEENT=== | ===HEENT=== | ||
* | *[[Rhinosinusitis|Sinusitis]]<ref name="pmid16698700">{{cite journal |vauthors=Bacciu A, Bacciu S, Mercante G, Ingegnoli F, Grasselli C, Vaglio A, Pasanisi E, Vincenti V, Garini G, Ronda N, Ferri T, Corradi D, Buzio C |title=Ear, nose and throat manifestations of Churg-Strauss syndrome |journal=Acta Otolaryngol. |volume=126 |issue=5 |pages=503–9 |date=May 2006 |pmid=16698700 |doi=10.1080/00016480500437435 |url=}}</ref> | ||
*[[Rhinitis]] | |||
*[[Nasal polyp|Nasal polyps]] | |||
* | *[[Otitis media]] | ||
* | *Hearing acuity may be reduced | ||
* [[ | **[[Weber test]] may be abnormal | ||
**[[Rinne test]] may be abnormal | |||
* Hearing acuity may be reduced | |||
*[[Weber test]] may be abnormal | |||
*[[Rinne test]] may be | |||
*Inflamed nares / congested nares | *Inflamed nares / congested nares | ||
*Facial tenderness | |||
* Facial tenderness | |||
===Neck=== | ===Neck=== | ||
* Neck examination of patients with [[eosinophilic granulomatosis with polyangiitis]] is usually normal. | * Neck examination of patients with [[eosinophilic granulomatosis with polyangiitis]] is usually normal. | ||
===Lungs=== | ===Lungs=== | ||
* [[Wheeze|Wheezing]] | The examination may show signs of:<ref name="pmid21674415">{{cite journal |vauthors=Dunogué B, Pagnoux C, Guillevin L |title=Churg-strauss syndrome: clinical symptoms, complementary investigations, prognosis and outcome, and treatment |journal=Semin Respir Crit Care Med |volume=32 |issue=3 |pages=298–309 |date=June 2011 |pmid=21674415 |doi=10.1055/s-0031-1279826 |url=}}</ref> | ||
* Expiratory ronchi | *Asthma | ||
**[[Wheeze|Wheezing]] | |||
**Expiratory ronchi | |||
*[[Pleural effusion]] | |||
*[[Pulmonary hypertension]](Basilar [[Rales|crackles]]) | |||
*[[ | |||
*[[ | |||
===Heart=== | ===Heart=== | ||
* | *Examination may show signs of [[pericarditis]], [[myocarditis]], [[Congestive heart failure|heart failure]], and myocardial infarction.<ref name="pmid26418389">{{cite journal |vauthors=Brucato A, Maestroni S, Masciocco G, Ammirati E, Bonacina E, Pedrotti P |title=[Cardiac involvement in Churg-Strauss syndrome] |language=Italian |journal=G Ital Cardiol (Rome) |volume=16 |issue=9 |pages=493–500 |date=September 2015 |pmid=26418389 |doi=10.1714/1988.21524 |url=}}</ref> | ||
**[[Chest pain]] | |||
**[[Pericardial friction rub]] | |||
**[[Heart sounds|S1]] | |||
**[[Heart sounds|S2]] | |||
**[[Heart murmur|Murmurs]] | |||
*[[ | |||
*[[ | |||
*[[Heart sounds | |||
*[[Heart sounds | |||
* | |||
===Abdomen=== | ===Abdomen=== | ||
Abdominal examination of patients with eosinophilic granulomatosis with polyangiitis may show : | Abdominal examination of patients with [[eosinophilic granulomatosis with polyangiitis]] may show : | ||
* [[Tenderness (medicine)|Abdominal tenderness]] | * [[Tenderness (medicine)|Abdominal tenderness]] | ||
* | * [[Abdominal guarding|Guarding]] | ||
* [[Abdominal mass]] may be found | |||
===Back=== | ===Back=== | ||
* Back examination of patients with [[eosinophilic granulomatosis with polyangiitis]] is usually normal. | * Back examination of patients with [[eosinophilic granulomatosis with polyangiitis]] is usually normal. | ||
===Genitourinary=== | ===Genitourinary=== | ||
* | * Examination may show signs of [[glomerulonephritis]] and [[Renal insufficiency|renal failure]]. (eg, [[Anemia|anaemia]], [[hypertension]], [[edema]], [[abdominal distension]]) | ||
===Neuromuscular=== | |||
* Patient is usually oriented to persons, place, and time. | * Patient is usually oriented to persons, place, and time. | ||
* [[Peripheral neuropathy]] | * [[Peripheral neuropathy]] | ||
* [[Mononeuritis multiplex]] - [[foot drop]], [[wrist drop]] | * [[Mononeuritis multiplex]] - [[foot drop]], [[wrist drop]]<ref name="pmid20050889">{{cite journal |vauthors=Wolf J, Bergner R, Mutallib S, Buggle F, Grau AJ |title=Neurologic complications of Churg-Strauss syndrome--a prospective monocentric study |journal=Eur. J. Neurol. |volume=17 |issue=4 |pages=582–8 |date=April 2010 |pmid=20050889 |doi=10.1111/j.1468-1331.2009.02902.x |url=}}</ref> | ||
* [[Nerve palsy|Cranial nerve palsy]] | * [[Nerve palsy|Cranial nerve palsy]] | ||
* [[Stroke]] | |||
===Extremities=== | ===Extremities=== | ||
* | * [[Paresthesia|Tingling and numbness]] of extremities. | ||
* [[Myalgia]] | |||
* [[Arthralgia]] | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
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{{WH}} | {{WH}} | ||
{{WS}} | {{WS}} | ||
[[Category: | [[Category: Rheumatology]] | ||
[[Category: Autoimmune disease]] | |||
Latest revision as of 00:51, 10 April 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Chandrakala Yannam, MD [2]
Overview
A comprehensive physical examination including pulmonary, ENT, neurologic, skin, abdominal and renal systems must be performed to help identify and properly diagnose eosinophilic granulomatosis with polyangiitis form other diseases. On examination, patients may show clinical manifestations of asthma (dyspnea, tachypnea), petechiae, palpable purpura, skin nodules, rhinitis, nasal polyposis, chest pain, abdominal pain, and neurologic manifestations. On auscultation, wheezing, rhonchi, friction rub, abnormal heart sounds may be found.
Physical Examination
Physical examination findings of patients with eosinophilic granulomatosis with polyangiitis depends on organ system involvement. 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 eosinophilic granulomatosis with polyangiitis.
Appearance of the Patient
- Patients with eosinophilic granulomatosis with polyangiitis usually appear ill.
Vital Signs
Skin
- Skin examination of patients with eosinophilic granulomatosis with polyangiitis may show:[1]
- Petechiae
- Ecchymosis
- Urticarial rash
- Purpura
- Nodules
HEENT
- Sinusitis[2]
- Rhinitis
- Nasal polyps
- Otitis media
- Hearing acuity may be reduced
- Weber test may be abnormal
- Rinne test may be abnormal
- Inflamed nares / congested nares
- Facial tenderness
Neck
- Neck examination of patients with eosinophilic granulomatosis with polyangiitis is usually normal.
Lungs
The examination may show signs of:[3]
- Asthma
- Wheezing
- Expiratory ronchi
- Pleural effusion
- Pulmonary hypertension(Basilar crackles)
Heart
- Examination may show signs of pericarditis, myocarditis, heart failure, and myocardial infarction.[4]
Abdomen
Abdominal examination of patients with eosinophilic granulomatosis with polyangiitis may show :
- Abdominal tenderness
- Guarding
- Abdominal mass may be found
Back
- Back examination of patients with eosinophilic granulomatosis with polyangiitis is usually normal.
Genitourinary
- Examination may show signs of glomerulonephritis and renal failure. (eg, anaemia, hypertension, edema, abdominal distension)
Neuromuscular
- Patient is usually oriented to persons, place, and time.
- Peripheral neuropathy
- Mononeuritis multiplex - foot drop, wrist drop[5]
- Cranial nerve palsy
- Stroke
Extremities
- Tingling and numbness of extremities.
- Myalgia
- Arthralgia
References
- ↑ Davis MD, Daoud MS, McEvoy MT, Su WP (August 1997). "Cutaneous manifestations of Churg-Strauss syndrome: a clinicopathologic correlation". J. Am. Acad. Dermatol. 37 (2 Pt 1): 199–203. PMID 9270504.
- ↑ Bacciu A, Bacciu S, Mercante G, Ingegnoli F, Grasselli C, Vaglio A, Pasanisi E, Vincenti V, Garini G, Ronda N, Ferri T, Corradi D, Buzio C (May 2006). "Ear, nose and throat manifestations of Churg-Strauss syndrome". Acta Otolaryngol. 126 (5): 503–9. doi:10.1080/00016480500437435. PMID 16698700.
- ↑ Dunogué B, Pagnoux C, Guillevin L (June 2011). "Churg-strauss syndrome: clinical symptoms, complementary investigations, prognosis and outcome, and treatment". Semin Respir Crit Care Med. 32 (3): 298–309. doi:10.1055/s-0031-1279826. PMID 21674415.
- ↑ Brucato A, Maestroni S, Masciocco G, Ammirati E, Bonacina E, Pedrotti P (September 2015). "[Cardiac involvement in Churg-Strauss syndrome]". G Ital Cardiol (Rome) (in Italian). 16 (9): 493–500. doi:10.1714/1988.21524. PMID 26418389.
- ↑ Wolf J, Bergner R, Mutallib S, Buggle F, Grau AJ (April 2010). "Neurologic complications of Churg-Strauss syndrome--a prospective monocentric study". Eur. J. Neurol. 17 (4): 582–8. doi:10.1111/j.1468-1331.2009.02902.x. PMID 20050889.