Aplastic anemia physical examination: Difference between revisions

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{{Aplastic anemia}}
{{Aplastic anemia}}
{{CMG}}
{{CMG}} {{shyam}} {{AE}}  {{N.F}}
==Overview==
==Overview==
Common physical examination findings of aplastic anemia include pale color, short stature, dyspnea, [[petechia|petechiae]], [[purpura]], [[ecchymoses]], [[jaundice]], [[pallor]], and [[bruise|bruises]]. Patients can present with [[leukoplakia|oral leukoplakia]], pharyngeal ulcers, [[gingivitis|necrotizing gingivitis]], [[tonsillitis|and tonsillitis]].
==Physical Examination==
==Physical Examination==


=== Appearance of the Patient ===
===Appearance of the Patient===
* Patients with aplastic anemia usually appear pale.
* [[Pallor]]<ref name="pmid29222240">{{cite journal| author=West AH, Churpek JE| title=Old and new tools in the clinical diagnosis of inherited bone marrow failure syndromes. | journal=Hematology Am Soc Hematol Educ Program | year= 2017 | volume= 2017 | issue= 1 | pages= 79-87 | pmid=29222240 | doi=10.1182/asheducation-2017.1.79 | pmc=6142587 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29222240  }} </ref>
* [[Short stature]]


=== Vital Signs ===
=== Vital Signs ===
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* [[Purpura]]
* [[Purpura]]
* [[Ecchymoses]]
* [[Ecchymoses]]
* [[Jaundice]]
* [[Jaundice]]
* [[Pallor]]
* [[Pallor]]
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* [[Microphthalmia|Microphthalmos]]
* [[Microphthalmia|Microphthalmos]]
* [[Leukoplakia|Oral leukoplakia]]
* [[Leukoplakia|Oral leukoplakia]]
* Pharyngeal ulcers.
* Pharyngeal ulcers
* [[Gingivitis|Necrotizing gingivitis]]
* [[Gingivitis|Necrotizing gingivitis]]
* [[Tonsillitis]]
* [[Tonsillitis]]
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* Neck examination of patients with aplastic anemia is usually normal.
* Neck examination of patients with aplastic anemia is usually normal.
=== Lungs ===
=== Lungs ===
* Pulmonary examination of patients with aplastic anemia is usually normal unless patients develop pneumonia.
* Pulmonary examination of patients with aplastic anemia is usually normal unless patients develop [[pneumonia]].
 
* Asymmetric chest expansion  
* Asymmetric chest expansion  
* Lungs are hyperresonant
* Hyperresonance
* Coarse [[crackles]] upon auscultation
* Coarse [[crackles]]  
* [[Rhonchi]]
* [[Rhonchi]]
* Decreased breath sounds
* Decreased breath sounds
* Tachypnea
* [[Tachypnea]]
*
* Reduced [[tactile fremitus]]
* Reduced [[tactile fremitus]]


=== Heart ===
=== Heart ===
* Cardiovascular examination of patients with [disease name] is usually normal.
* [[Cardiac arrhythmia|Arrythmias]]
OR
* [[Heart murmur|Murmur]]
* Chest tenderness upon palpation
* Chest pain
* 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 S1.2C the .22lub.22.28components M1 and T1.29|S1]]
* [[Heart sounds#Second heart tone S2 the .22dub.22.28components A2 and P2.29|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 stethoscope
 
=== Abdomen ===
=== Abdomen ===
* Abdominal examination of patients with [disease name] is usually normal.
OR
* [[Abdominal distention]]
* [[Abdominal distention]]
* [[Abdominal tenderness]] in the right/left upper/lower abdominal quadrant
* [[Diarrhea]]
* [[Rebound tenderness]] (positive Blumberg sign)
* [[Splenomegaly]]
* A palpable abdominal mass in the right/left upper/lower abdominal quadrant
* [[Hepatomegaly]]
* 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 aplastic anemia 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.
* [[Hypogonadism]]
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 aplastic anemia 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)


*
*
==References==
==References==
{{reflist|2}}
{{reflist|2}}

Latest revision as of 02:26, 3 December 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Shyam Patel [2] Associate Editor(s)-in-Chief: Nazia Fuad M.D.

Overview

Common physical examination findings of aplastic anemia include pale color, short stature, dyspnea, petechiae, purpura, ecchymoses, jaundice, pallor, and bruises. Patients can present with oral leukoplakia, pharyngeal ulcers, necrotizing gingivitis, and tonsillitis.

Physical Examination

Appearance of the Patient

Vital Signs

Skin

HEENT

Neck

  • Neck examination of patients with aplastic anemia is usually normal.

Lungs

Heart

Abdomen

Back

  • Back examination of patients with aplastic anemia is usually normal.

Genitourinary

Neuromuscular

  • Neuromuscular examination of patients with aplastic anemia is usually normal.

References

  1. West AH, Churpek JE (2017). "Old and new tools in the clinical diagnosis of inherited bone marrow failure syndromes". Hematology Am Soc Hematol Educ Program. 2017 (1): 79–87. doi:10.1182/asheducation-2017.1.79. PMC 6142587. PMID 29222240.