Appendix cancer physical examination: Difference between revisions

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==Physical Examination==
==Physical Examination==
*  
*  
'''Pulse'''
* Patients with appendix cancer may appear normal, pale or diaphoretic.
* [[Tachycardia]]
'''Blood Pressure'''
*
 
=== Skin[edit | edit source] ===
*
 
=== Neck[edit | edit source] ===
* [[Lymphadenopathy|Cervical lymphadenopathy]]
 
=== Lungs[edit | edit source] ===
* [[Wheezing]]
 
=== Heart[edit | edit source] ===
* [[Murmur|Systolic or diastolic murmur]]
 
=== Extremities[edit | edit source] ===
* [[Edema|Lower limb edema]]
 
*  
*  
*
* Patients with appendix cancer may appear normal, pale or diaphoretic.
* Abdominal examination may be remarkable for:
'''Palpation'''
* The abdominal wall is very sensitive to mild palpation
* [[Rebound tenderness]]
* [[Abdominal guarding]]
* [[Rovsing's sign]]
* [[Psoas sign]]
'''Rectal examination'''
* Tenderness in the [[rectovesical pouch]]


*Physical examination of patients with appendix cancer is usually normal.
*Physical examination of patients with appendix cancer is usually normal.
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===HEENT===
===HEENT===
* HEENT examination of patients with [disease name] is usually normal.
* HEENT examination of patients with appendix cancer is usually normal.
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.
* Neck examination of patients with appendiceal cancer is usually normal.
OR
* [[Lymphadenopathy|Cervical lymphadenopathy]] might be present.
*[[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 appendix cancer is usually normal.
OR
* [[Wheezing]] : if the patient develop carcinoid syndrome
* 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 appendix cancer is usually normal.
OR
but
*Chest tenderness upon palpation
*if the patient develop carcinoid syndrome [[Murmur|systolic or diastolic murmur]] might be present
*PMI within 2 cm of the sternum  (PMI) / Displaced point of maximal impulse (PMI) suggestive of ____
*Right heart murmurs specially TR is prevalent.
*[[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 stethoscope


===Abdomen===
===Abdomen===
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*[[Hepatomegaly]] / [[splenomegaly]] / [[hepatosplenomegaly]]
*[[Hepatomegaly]] / [[splenomegaly]] / [[hepatosplenomegaly]]
*Additional findings, such as obturator test, psoas test, McBurney point test, Murphy test
*Additional findings, such as obturator test, psoas test, McBurney point test, Murphy test
* Abdominal examination may be remarkable for:
'''Palpation'''
* The abdominal wall is very sensitive to mild palpation
* [[Rebound tenderness]]
* [[Abdominal guarding]]
* [[Rovsing's sign]]
* [[Psoas sign]]
'''Rectal examination'''
* Tenderness in the [[rectovesical pouch]]


===Back===
===Back===
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===Extremities===
===Extremities===
* Extremities examination of patients with [disease name] is usually normal.
* Extremities examination of patients with appendix cancer is usually normal.
OR
 
*[[Clubbing]]
*rarely patients with carcionid syndrome might present with [[Edema|lower limb edema]]
*[[Cyanosis]]
*Pitting/non-pitting [[edema]] of the upper/lower extremities
*Muscle atrophy
*Fasciculations in the upper/lower extremity


==References==
==References==

Revision as of 19:12, 24 January 2019

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

Overview

Patients with appendix cancer usually appear normal, pale or diaphoretic. If the patient with appendix cancer present with acute appendicitis which is quit common, abdominal tenderness, Rebound tenderness, abdominal guarding, Rovsing's sign, as well as Psoas sign might be present. Around 5% of the patients with appendiceal carcinoid tumors might develop carcinoid syndrome. Common physical examination findings of carcinoid syndrome include dehydration due to diarrhea, tachycardia as well as facial flushing, right heart murmurs like TR murmur is quit common. In patients with carcinoid syndrome, the presence of dermatitis, diarrhea, and dementia on physical examination is highly suggestive of of Pellagra disease.

Physical Examination

  • Patients with appendix cancer may appear normal, pale or diaphoretic.
  • Physical examination of patients with appendix cancer is usually normal.
  • Around 5% of the patients with appendiceal carcinoid tumors might develop carcinoid syndrome.
  • Common physical examination findings of carcinoid syndrome include dehydration due to diarrhea, tachycardia as well as facial flushing, right heart murmurs like TR murmur is quit common.
  • In patients with carcinoid syndrome, the presence of dermatitis, diarrhea, and dementia on physical examination is highly suggestive of of Pellagra disease.

Appearance of the Patient

  • Patients with appendix cancer usually appear normal but might be pale or diaphoretic, or even present with a facial flushing.

Vital Signs

  • Fever might be present in patients presenting with appendicitis.
  • Tachycardia is prevalent in patients with carcinoid syndrome as well as patients with appendicitis.
  • Tachypnea
  • Hypertension

Skin

  • Skin examination of patients with appendix cancer is usually normal.

in the presence of carcinoid syndrome the following might be present:

HEENT

  • HEENT examination of patients with appendix cancer is usually normal.

Neck

Lungs

  • Pulmonary examination of patients with appendix cancer is usually normal.
  • Wheezing : if the patient develop carcinoid syndrome

Heart

  • Cardiovascular examination of patients with appendix cancer is usually normal.

but

Abdomen

  • Abdominal examination of patients with [disease name] is usually normal.

OR

Palpation

Rectal examination

Back

  • Back examination of patients with [disease name] is usually normal.

OR

  • Point tenderness over __ vertebrae (e.g. L3-L4)
  • Sacral edema
  • Costovertebral angle tenderness bilaterally/unilaterally
  • Buffalo hump

Genitourinary

  • Genitourinary examination of patients with [disease name] is usually normal.

OR

  • A pelvic/adnexal mass may be palpated
  • Inflamed mucosa
  • Clear/(color), foul-smelling/odorless penile/vaginal discharge

Neuromuscular

  • Neuromuscular examination of patients with [disease name] 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 examination of patients with appendix cancer is usually normal.

References

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