Macrocytic anemia physical examination

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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 gl;lossitis, pallor, mouth ulcers.

Physical Examination

Appearance of the Patient

• Patients with megaloblastic anemia usually appear pale. fatigued

Vital Signs

• High-grade / low-grade fever
• Tachycardia with regular pulse
• Weak/bounding pulse / pulsus alternans / paradoxical pulse / asymmetric pulse

Skin

• Pallor
• Vitiligo- in autoimmune diseases related to pernicious anemia
• Jaundice may be seen

HEENT

• Pale conjunctiva
• Optic atrophy can be seen on fundus exam
• Icterus can be seen
• Glossitis
• Mouth ulcers

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:
  • Tremors

References

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