Reactive arthritis physical examination: Difference between revisions

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===HEENT===
===HEENT===
* Ophthalmoscopic exam may be abnormal with findings of  conjunctivitis.  
* Ophthalmoscopic exam may be abnormal with findings of  conjunctivitis.  
* As the disease progresses other findings such as scleritis, episcleritis;, and corneal ulceration may be present
* As the disease progresses other findings such as scleritis, episcleritis, and corneal ulceration may be present.
* Extra-ocular movements may be abnormal
*Pupils non-reactive to light / non-reactive to accommodation / non-reactive to neither light nor accommodation
*
* 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
*[[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 severe reactive arthritis may have:
OR
* Myocarditis
*Chest tenderness upon palpation
* Pericarditis
*PMI within 2 cm of the sternum  (PMI) / Displaced point of maximal impulse (PMI) suggestive of ____
* Aortitis
*[[Heave]] / [[thrill]]
* Aortic regurgitation
*[[Friction rub]]
* Transient conduction abnormalities
*[[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.
* Diarrhea
 
* Abdominal pain
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.
* Urethritis with erythema, edema and clear mucoid discharge.
OR
* Spread of infection may further lead to prostatitis (males) or cervicitis, cystitis, salpingo-oophoritis  and vulvovaginitis (females).
*A pelvic/adnexal mass may be palpated
* Circinate balanitis (balanitis circinata)pyelonephritis; bartholinitis
*Inflamed mucosa
* Bartholinitis
*Clear/(color), foul-smelling/odorless penile/vaginal discharge


===Neuromuscular===
===Neuromuscular===
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*Muscle atrophy
*Muscle atrophy
*Fasciculations in the upper/lower extremity
*Fasciculations in the upper/lower extremity




Revision as of 15:40, 6 April 2018

Reactive arthritis Microchapters

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

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].

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 of patients with reactive arthritis is usually remarkable for arthritis, conjunctivitis, and urethritis.

Appearance of the Patient

  • Patients with reactive arthritis usually appear fatigued.

Vital Signs

  • Low-grade fever

Skin

  • Skin examination of patients with reactive arthritis presents with onychodystrophy and keratoderma blennorrhagicum (commonly).

HEENT

  • Ophthalmoscopic exam may be abnormal with findings of conjunctivitis.
  • As the disease progresses other findings such as scleritis, episcleritis, and corneal ulceration may be present.

Heart

Cardiovascular examination of patients with severe reactive arthritis may have:

  • Myocarditis
  • Pericarditis
  • Aortitis
  • Aortic regurgitation
  • Transient conduction abnormalities

Abdomen

  • Diarrhea
  • Abdominal pain

Genitourinary

  • Urethritis with erythema, edema and clear mucoid discharge.
  • Spread of infection may further lead to prostatitis (males) or cervicitis, cystitis, salpingo-oophoritis and vulvovaginitis (females).
  • Circinate balanitis (balanitis circinata)pyelonephritis; bartholinitis
  • Bartholinitis

Neuromuscular

  • Neuromuscular examination of patients with [disease name] 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 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









Physical Examination

There is pain, swelling, redness, and heat in the joints.

Images

Gallery

Skin

Extremities
Genitalia
Eye

References

  1. ↑ 1.0 1.1 "Public Health Image Library (PHIL)".
  2. ↑ 2.00 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 2.09 2.10 2.11 2.12 2.13 2.14 2.15 2.16 2.17 2.18 2.19 2.20 2.21 2.22 2.23 2.24 2.25 2.26 2.27 2.28 2.29 2.30 2.31 2.32 2.33 2.34 2.35 2.36 2.37 2.38 2.39 2.40 2.41 2.42 2.43 2.44 "Dermatology Atlas".


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