Small cell carcinoma of the lung physical examination: Difference between revisions
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/* Physical Examination{{cite journal| author=Spiro SG, Gould MK, Colice GL, American College of Chest Physicians| title=Initial evaluation of the patient with lung cancer: symptoms, signs, laboratory tests, and paraneoplastic syndromes: ACCP evidenced... |
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===General Appearance=== | ===General Appearance=== | ||
*[[Cachexia]] ([[weight loss]] and [[anorexia]]) | *[[Cachexia]] ([[weight loss]] and [[anorexia]]) may be present | ||
* Central [[obesity]] (suggestive of [[Cushing's syndrome]]) | * Central [[obesity]] (suggestive of [[Cushing's syndrome]]) may be present | ||
*[[Jaundice]] (suggestive of liver [[metastasis]]) | *[[Jaundice]] (suggestive of liver [[metastasis]]) may be present | ||
*[[Pale skin]] (suggestive of [[anemia of chronic disease]]) | *[[Pale skin]] (suggestive of [[anemia of chronic disease]]) may be present | ||
*[[Cyanosis]] (suggestive of severe [[dyspnea]]) | *[[Cyanosis]] (suggestive of severe [[dyspnea]]) may be present | ||
*[[Lymphadenopathy]] (> 1 cm) | *[[Lymphadenopathy]] (> 1 cm) may be present | ||
* [[Dehydration]] (suggestive of [[hypercalcemia]]) | * [[Dehydration]] (suggestive of [[hypercalcemia]]) may be present | ||
=== | ===Head=== | ||
* Moon facies (suggestive of [[Cushing's syndrome]]) may be present | |||
* [[Swelling]] of the face, neck, trunk, and arms (suggestive of [[superior vena cava syndrome]]) may be present | |||
===Eyes=== | |||
* Yellow discoloration of the [[sclera]] (suggestive of [[jaundice]] due to liver [[metastasis]]) may be present | |||
* Conjunctival [[pallor]] (suggestive of [[anemia of chronic disease]]) may be present | |||
*[[Miosis]], ipsilateral [[ptosis]] and lack of facial sweating (suggestive of [[Horner's syndrome]]) may be present | |||
* Yellow discoloration of the [[sclera]] (suggestive of [[jaundice]] due to liver [[metastasis]]) | |||
* Conjunctival [[pallor]] (suggestive of [[anemia of chronic disease]]) | |||
*[[Miosis]], ipsilateral [[ptosis]] and lack of facial sweating (suggestive of [[Horner's syndrome]]) | |||
Shown below is an image depicting ptosis in a patient with [[Horner's syndrome]]. | Shown below is an image depicting ptosis in a patient with [[Horner's syndrome]]. | ||
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</div> | </div> | ||
===Throat=== | |||
*[[Hoarseness]] ( suggestive of compression of the [[recurrent laryngeal nerve]]) | *[[Hoarseness]] ( suggestive of compression of the [[recurrent laryngeal nerve]]) may be present | ||
===Lungs=== | ===Lungs=== | ||
* | * Unilateral decreased air entry may be present | ||
* Unilateral [[wheeze]] | * Unilateral [[wheeze]] may be present | ||
* Decreased air entry in the bases of the lungs and/or [[crackles]] (suggestive of [[Pleural effusion]]) | * Decreased air entry in the bases of the lungs and/or [[crackles]] (suggestive of [[Pleural effusion]]) may be present | ||
===Abdomen=== | ===Abdomen=== | ||
*[[Hepatomegaly]] (> 13 cm span) (suggestive of liver [[metastasis]]) | *[[Hepatomegaly]] (> 13 cm span) (suggestive of liver [[metastasis]]) may be present | ||
===Musculoskeletal system=== | ===Musculoskeletal system=== | ||
*[[Digital clubbing]] | *[[Digital clubbing]] may be present | ||
*[[Bone]] [[tenderness]] (suggestive of [[bone]] [[metastasis]]) | *[[Bone]] [[tenderness]] (suggestive of [[bone]] [[metastasis]]) may be present | ||
*[[Osteoarthropathy]]: painful symmetrical arthropathy of the knees, wrist, and knees, and periosteal new [[bone]] formation. | *[[Osteoarthropathy]] may be present: painful symmetrical arthropathy of the knees, wrist, and knees, and periosteal new [[bone]] formation. | ||
Shown below is an image depicting [[digital clubbing]]. | Shown below is an image depicting [[digital clubbing]]. | ||
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===Neurological=== | ===Neurological=== | ||
* [[Weakness]] of the proximal muscles of lower extremities, abnormal [[gait]], [[autonomic dysfunction]], and [[paresthesia]] (suggestive of [[Lambert-Eaton syndrome]])<ref name="pmid21565397">{{cite journal| author=van Meerbeeck JP, Fennell DA, De Ruysscher DK| title=Small-cell lung cancer. | journal=Lancet | year= 2011 | volume= 378 | issue= 9804 | pages= 1741-55 | pmid=21565397 | doi=10.1016/S0140-6736(11)60165-7 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21565397 }} </ref> | * [[Weakness]] of the proximal muscles of lower extremities, abnormal [[gait]], [[autonomic dysfunction]], and [[paresthesia]] (suggestive of [[Lambert-Eaton syndrome]]) may be present<ref name="pmid21565397">{{cite journal| author=van Meerbeeck JP, Fennell DA, De Ruysscher DK| title=Small-cell lung cancer. | journal=Lancet | year= 2011 | volume= 378 | issue= 9804 | pages= 1741-55 | pmid=21565397 | doi=10.1016/S0140-6736(11)60165-7 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21565397 }} </ref> | ||
* [[Altered mental status]], [[seizures]], [[memory loss]], space and time [[disorientation]], with or without [[dementia]] (suggestive of [[limbic encephalitis]] and [[encephalomyelitis]])<ref name="pmid21565397">{{cite journal| author=van Meerbeeck JP, Fennell DA, De Ruysscher DK| title=Small-cell lung cancer. | journal=Lancet | year= 2011 | volume= 378 | issue= 9804 | pages= 1741-55 | pmid=21565397 | doi=10.1016/S0140-6736(11)60165-7 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21565397 }} </ref> | * [[Altered mental status]], [[seizures]], [[memory loss]], space and time [[disorientation]], with or without [[dementia]] (suggestive of [[limbic encephalitis]] and [[encephalomyelitis]]) may occur<ref name="pmid21565397">{{cite journal| author=van Meerbeeck JP, Fennell DA, De Ruysscher DK| title=Small-cell lung cancer. | journal=Lancet | year= 2011 | volume= 378 | issue= 9804 | pages= 1741-55 | pmid=21565397 | doi=10.1016/S0140-6736(11)60165-7 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21565397 }} </ref> | ||
* [[Ataxia]], [[dysarthria]], severe [[vertigo]] (suggestive of [[paraneoplastic cerebellar degeneration]])<ref name="pmid21565397">{{cite journal| author=van Meerbeeck JP, Fennell DA, De Ruysscher DK| title=Small-cell lung cancer. | journal=Lancet | year= 2011 | volume= 378 | issue= 9804 | pages= 1741-55 | pmid=21565397 | doi=10.1016/S0140-6736(11)60165-7 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21565397 }} </ref> | * [[Ataxia]], [[dysarthria]], severe [[vertigo]] (suggestive of [[paraneoplastic cerebellar degeneration]]) may occur<ref name="pmid21565397">{{cite journal| author=van Meerbeeck JP, Fennell DA, De Ruysscher DK| title=Small-cell lung cancer. | journal=Lancet | year= 2011 | volume= 378 | issue= 9804 | pages= 1741-55 | pmid=21565397 | doi=10.1016/S0140-6736(11)60165-7 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21565397 }} </ref> | ||
* Focal neurologic symptoms, [[seizures]], [[confusion]], and personality changes (suggestive of [[brain]] metastasis) | * Focal neurologic symptoms, [[seizures]], [[confusion]], and personality changes (suggestive of [[brain]] metastasis) | ||
===Skin=== | ===Skin=== | ||
* Acquired [[tylosis]] | * Acquired [[tylosis]] may be present | ||
* [[Tripe palms]]<ref name="pmid8638207">{{cite journal| author=Mullans EA, Cohen PR| title=Tripe palms: a cutaneous paraneoplastic syndrome. | journal=South Med J | year= 1996 | volume= 89 | issue= 6 | pages= 626-7 | pmid=8638207 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8638207 }} </ref> | * [[Tripe palms]] may be present<ref name="pmid8638207">{{cite journal| author=Mullans EA, Cohen PR| title=Tripe palms: a cutaneous paraneoplastic syndrome. | journal=South Med J | year= 1996 | volume= 89 | issue= 6 | pages= 626-7 | pmid=8638207 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8638207 }} </ref> | ||
*[[Erythema gyratum repens]] (rare) | *[[Erythema gyratum repens]] (rare) | ||
Revision as of 19:11, 26 June 2014
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Small Cell Carcinoma of the Lung Microchapters |
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Differentiating Small Cell Carcinoma of the Lung from other Diseases |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editors-in-Chief: Guillermo Rodriguez Nava, M.D. [2]
Overview
Many authors have concluded that performing a complete assessment, with a detailed history and physical examination, is useful for identifying patients with a higher likelihood of metastases.[1]
Physical Examination[1][2][3]
Vital Signs
- Fever (in up to 20% of patients with lung cancer)
- Hypertension (can be present in case of Cushing's syndrome)
General Appearance
- Cachexia (weight loss and anorexia) may be present
- Central obesity (suggestive of Cushing's syndrome) may be present
- Jaundice (suggestive of liver metastasis) may be present
- Pale skin (suggestive of anemia of chronic disease) may be present
- Cyanosis (suggestive of severe dyspnea) may be present
- Lymphadenopathy (> 1 cm) may be present
- Dehydration (suggestive of hypercalcemia) may be present
Head
- Moon facies (suggestive of Cushing's syndrome) may be present
- Swelling of the face, neck, trunk, and arms (suggestive of superior vena cava syndrome) may be present
Eyes
- Yellow discoloration of the sclera (suggestive of jaundice due to liver metastasis) may be present
- Conjunctival pallor (suggestive of anemia of chronic disease) may be present
- Miosis, ipsilateral ptosis and lack of facial sweating (suggestive of Horner's syndrome) may be present
Shown below is an image depicting ptosis in a patient with Horner's syndrome.
-
Horner's Syndrome
Throat
- Hoarseness ( suggestive of compression of the recurrent laryngeal nerve) may be present
Lungs
- Unilateral decreased air entry may be present
- Unilateral wheeze may be present
- Decreased air entry in the bases of the lungs and/or crackles (suggestive of Pleural effusion) may be present
Abdomen
- Hepatomegaly (> 13 cm span) (suggestive of liver metastasis) may be present
Musculoskeletal system
- Digital clubbing may be present
- Bone tenderness (suggestive of bone metastasis) may be present
- Osteoarthropathy may be present: painful symmetrical arthropathy of the knees, wrist, and knees, and periosteal new bone formation.
Shown below is an image depicting digital clubbing.
-
Clubbing -
Clubbing
Neurological
- Weakness of the proximal muscles of lower extremities, abnormal gait, autonomic dysfunction, and paresthesia (suggestive of Lambert-Eaton syndrome) may be present[2]
- Altered mental status, seizures, memory loss, space and time disorientation, with or without dementia (suggestive of limbic encephalitis and encephalomyelitis) may occur[2]
- Ataxia, dysarthria, severe vertigo (suggestive of paraneoplastic cerebellar degeneration) may occur[2]
- Focal neurologic symptoms, seizures, confusion, and personality changes (suggestive of brain metastasis)
Skin
- Acquired tylosis may be present
- Tripe palms may be present[4]
- Erythema gyratum repens (rare)
References
- ↑ 1.0 1.1 Spiro SG, Gould MK, Colice GL, American College of Chest Physicians (2007). "Initial evaluation of the patient with lung cancer: symptoms, signs, laboratory tests, and paraneoplastic syndromes: ACCP evidenced-based clinical practice guidelines (2nd edition)". Chest. 132 (3 Suppl): 149S–160S. doi:10.1378/chest.07-1358. PMID 17873166.
- ↑ 2.0 2.1 2.2 2.3 van Meerbeeck JP, Fennell DA, De Ruysscher DK (2011). "Small-cell lung cancer". Lancet. 378 (9804): 1741–55. doi:10.1016/S0140-6736(11)60165-7. PMID 21565397.
- ↑ Sher T, Dy GK, Adjei AA (2008). "Small cell lung cancer". Mayo Clin Proc. 83 (3): 355–67. doi:10.4065/83.3.355. PMID 18316005.
- ↑ Mullans EA, Cohen PR (1996). "Tripe palms: a cutaneous paraneoplastic syndrome". South Med J. 89 (6): 626–7. PMID 8638207.