Macrocytic anemia physical examination: Difference between revisions
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==Overview== | ==Overview== | ||
Common physical examination findings of megaloblastic anemia include | Common physical examination findings of [[megaloblastic anemia]] include [[glossitis]], [[pallor]], [[mouth ulcers]], [[vitiligo]], [[Subacute combined degeneration of spinal cord|subacute combined degeneration]], and positive [[Romberg's test|Romberg's]] sign. | ||
==Physical Examination== | ==Physical Examination== | ||
Physical examination includes the following: <ref name="pmid292640272">{{cite journal |vauthors=Nagao T, Hirokawa M |title=Diagnosis and treatment of macrocytic anemias in adults |journal=J Gen Fam Med |volume=18 |issue=5 |pages=200–204 |date=October 2017 |pmid=29264027 |pmc=5689413 |doi=10.1002/jgf2.31 |url=}}</ref> | |||
===Appearance of the Patient=== | ===Appearance of the Patient=== | ||
*Patients with megaloblastic anemia usually appear pale | *Patients with megaloblastic anemia usually appear pale and fatigued | ||
===Vital Signs=== | ===Vital Signs=== | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Amandeep Singh M.D.[2]
Overview
Common physical examination findings of megaloblastic anemia include glossitis, pallor, mouth ulcers, vitiligo, subacute combined degeneration, and positive Romberg's sign.
Physical Examination
Physical examination includes the following: [1]
Appearance of the Patient
- Patients with megaloblastic anemia usually appear pale and fatigued
Vital Signs
- High-grade / low-grade fever
- Tachycardia with regular pulse
- Weak/bounding pulse / pulsus alternans / paradoxical pulse / asymmetric pulse
Skin
HEENT
- Pale conjunctiva
- Optic atrophy can be seen on fundus exam
- Icterus can be seen
- Glossitis
- Mouth ulcers[2]
Neck
- Neck examination of patients with megaloblastic anemia is usually normal.
Lungs
- Pulmonary examination of patients with megaloblastic anemia is usually normal.
Heart
- Heave / thrill
- S1, S2 are normal.
- A low grade early systolic murmur at the mitral area can be heard using the bell/diaphgram of the stethoscope
Abdomen
- Abdominal examination of patients with megaloblastic anemia is usually normal.
Back
- Back examination of patients with megaloblastic anemia is usually normal.
Genitourinary
- Genitourinary examination of patients with megaloblastic anemia is usually normal.
Neuromuscular
- Patient is usually oriented to persons, place, and time
- 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
- Can proceed to paraplegia
- Unilateral/bilateral sensory loss in the upper/lower extremity
- Position and vibration sense is impaired
- Abnormal gait
- Positive Romberg's test
- Positive Lhermitte's sign
- Unilateral/bilateral tremor
Extremities
- Extremities examination of patients with megaloblastic anemia may show:
References
- ↑ Nagao T, Hirokawa M (October 2017). "Diagnosis and treatment of macrocytic anemias in adults". J Gen Fam Med. 18 (5): 200–204. doi:10.1002/jgf2.31. PMC 5689413. PMID 29264027.
- ↑ Devalia V, Hamilton MS, Molloy AM (August 2014). "Guidelines for the diagnosis and treatment of cobalamin and folate disorders". Br. J. Haematol. 166 (4): 496–513. doi:10.1111/bjh.12959. PMID 24942828.