Renal cell carcinoma physical examination: Difference between revisions

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{{CMG}}
__NOTOC__
{{Renal cell carcinoma}}
{{Renal cell carcinoma}}
 
{{CMG}} {{AE}} {{F.K}}
==Overview==
==Overview==
Common physical examination findings of renal cell carcinoma include low [[body mass index]], high [[blood pressure]], palpation of [[abdominal mass]], auscultation of [[abdominal bruit]], [[varicocele]], [[muscle atrophy]], skin [[pallor]], facial [[flushing]], and supraclavicular [[lymphadenopathy]].
Common physical examination findings of renal cell carcinoma include low [[body mass index]], high [[blood pressure]], palpation of [[abdominal mass]], auscultation of [[abdominal bruit]], [[varicocele]], [[muscle atrophy]], skin [[pallor]], facial [[flushing]], and supraclavicular [[lymphadenopathy]].


==Physical Examination==
==Physical Examination==
Physical examination findings are generally not revealing. Physical exam findings are not specific. A full physical exam should be conducted in all renal cell carcinoma patients in search of metastasis. In some patients, the presence of the following may be helpful for the diagnosis of renal cell carcinoma:
Physical examination of patients with [disease name] is usually remarkable for [[pallor]], low [[body mass index]], high [[blood pressure]], palpation of [[abdominal mass]] and auscultation of [[abdominal bruit]].<ref name="pmid22112490">{{cite journal |vauthors=Cairns P |title=Renal cell carcinoma |journal=Cancer Biomark |volume=9 |issue=1-6 |pages=461–73 |date=2010 |pmid=22112490 |pmc=3308682 |doi=10.3233/CBM-2011-0176 |url=}}</ref><ref name="pmid26411108">{{cite journal |vauthors=Ata-ur-Rehman R, Ashraf S, Rahim J, Hussain N, Jamil MN, Tahir MM |title=CLINICAL PRESENTATION OF RENAL CELL CARCINOMA |journal=J Ayub Med Coll Abbottabad |volume=27 |issue=2 |pages=326–8 |date=2015 |pmid=26411108 |doi= |url=}}</ref><ref name="pmid12918314">{{cite journal |vauthors=Espinosa Bravo R, Lemourt Oliva M, Pérez Monzón AF, Puente Guillen M, Navarro Cutiño M, Sandoval López O, de la C Fuentes Milera A |title=[Renal cell carcinoma and simultaneous left varicocele] |language=Spanish; Castilian |journal=Arch. Esp. Urol. |volume=56 |issue=5 |pages=533–5 |date=June 2003 |pmid=12918314 |doi= |url=}}</ref><ref name="pmid16985554">{{cite journal |vauthors=Chin AI, Lam JS, Figlin RA, Belldegrun AS |title=Surveillance strategies for renal cell carcinoma patients following nephrectomy |journal=Rev Urol |volume=8 |issue=1 |pages=1–7 |date=2006 |pmid=16985554 |pmc=1471767 |doi= |url=}}</ref>
*Low [[body mass index]] (BMI)
*High [[blood pressure]]
*Palpation of [[abdominal mass]]
*Auscultation of [[abdominal bruit]]
*[[Varicocele]]
*[[Muscle atrophy]]
*Skin [[pallor]]
*Facial [[flushing]]
*Supraclavicular [[lymphadenopathy]]
*Abnormal neurological exam
 
 
==Physical Examination==
Physical examination of patients with [disease name] is usually normal.
 
OR
 
Physical examination of patients with [disease name] is usually remarkable for [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].
 
===Appearance of the Patient===
===Appearance of the Patient===
*Patients with [disease name] usually appear [general appearance].  
*Patients with renal cell carcinoma usually appear cachexectic.  


===Vital Signs===
===Vital Signs===
 
*Hyperthermia may be present.
*High-grade / low-grade fever
*High low blood pressure with normal pulse pressure  
*[[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.
OR
*[[Cyanosis]]
*[[Jaundice]]
* [[Pallor]]
* [[Pallor]]
* Bruises
<gallery widths="150px">
UploadedImage-01.jpg | Description {{dermref}}
UploadedImage-02.jpg | Description {{dermref}}
</gallery>


===HEENT===
===HEENT===
* HEENT examination of patients with [disease name] is usually normal.
*Facial [[flushing]] may be present.
OR
* Abnormalities of the head/hair may include ___
* Evidence of trauma
* Icteric sclera
* [[Nystagmus]]
* Extra-ocular movements may be abnormal
*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===
* Neck examination of patients with [disease name] is usually normal.
*Supraclavicular [[lymphadenopathy]]
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 renal cell carcinoma is usually normal.
OR
* Asymmetric chest expansion OR decreased chest expansion
*Lungs are hyporesonant OR hyperresonant
*Fine/coarse [[crackles]] upon auscultation of the lung bases/apices unilaterally/bilaterally
*Rhonchi
*Vesicular breath sounds OR distant breath sounds
*Expiratory wheezing OR inspiratory wheezing with normal OR 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 renal cell carcinoma 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.
*Palpation of [[abdominal mass]]
OR
*Auscultation of [[abdominal bruit]]
*[[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 renal cell carcinoma 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.
*[[Varicocele]] may be present.
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 renal cell carcinoma 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.
*[[Muscle atrophy]] may be present
OR
*[[Clubbing]]
*[[Cyanosis]]  
*Pitting/non-pitting [[edema]] of the upper/lower extremities
*Muscle atrophy
*Fasciculations in the upper/lower extremity


==References==
==References==

Latest revision as of 14:38, 27 July 2018

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

Overview

Common physical examination findings of renal cell carcinoma include low body mass index, high blood pressure, palpation of abdominal mass, auscultation of abdominal bruit, varicocele, muscle atrophy, skin pallor, facial flushing, and supraclavicular lymphadenopathy.

Physical Examination

Physical examination of patients with [disease name] is usually remarkable for pallor, low body mass index, high blood pressure, palpation of abdominal mass and auscultation of abdominal bruit.[1][2][3][4]

Appearance of the Patient

  • Patients with renal cell carcinoma usually appear cachexectic.

Vital Signs

  • Hyperthermia may be present.
  • High low blood pressure with normal pulse pressure

Skin

HEENT

Neck

Lungs

  • Pulmonary examination of patients with renal cell carcinoma is usually normal.

Heart

  • Cardiovascular examination of patients with renal cell carcinoma is usually normal.

Abdomen

Back

  • Back examination of patients with renal cell carcinoma is usually normal.

Genitourinary

Neuromuscular

  • Neuromuscular examination of patients with renal cell carcinoma is usually normal.

Extremities

References

  1. ↑ Cairns P (2010). "Renal cell carcinoma". Cancer Biomark. 9 (1–6): 461–73. doi:10.3233/CBM-2011-0176. PMC 3308682. PMID 22112490.
  2. ↑ Ata-ur-Rehman R, Ashraf S, Rahim J, Hussain N, Jamil MN, Tahir MM (2015). "CLINICAL PRESENTATION OF RENAL CELL CARCINOMA". J Ayub Med Coll Abbottabad. 27 (2): 326–8. PMID 26411108.
  3. ↑ Espinosa Bravo R, Lemourt Oliva M, Pérez Monzón AF, Puente Guillen M, Navarro Cutiño M, Sandoval López O, de la C Fuentes Milera A (June 2003). "[Renal cell carcinoma and simultaneous left varicocele]". Arch. Esp. Urol. (in Spanish; Castilian). 56 (5): 533–5. PMID 12918314. Vancouver style error: missing comma (help)
  4. ↑ Chin AI, Lam JS, Figlin RA, Belldegrun AS (2006). "Surveillance strategies for renal cell carcinoma patients following nephrectomy". Rev Urol. 8 (1): 1–7. PMC 1471767. PMID 16985554.
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