Germinoma physical examination

Germinoma Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Epidemiology and Demographics
Risk Factors
Screening
Differentiating Germinoma from other Diseases
Natural History, Complications and Prognosis
Diagnosis
Staging
History and Symptoms
Physical Examination
Laboratory Findings
Chest X Ray
CT
MRI
Ultrasound
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Germinoma physical examination On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Germinoma physical examination All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA onGerminoma physical examination
CDC on Germinoma physical examination
Germinoma physical examination in the news
on Germinoma physical examination
Directions to Hospitals Treating Germinoma
Risk calculators and risk factors for Germinoma physical examination

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Simrat Sarai, M.D. [2]

Physical Examination

The clinical evaluation for germ cell tumors should include the following:

• General physical examination
• Check of growth parameters
• Careful neurological evaluation
• Assessment of primary and secondary sexual characteristics
• Ophthalmological exam.

Radiographic characteristics of CNS germ cell tumors GCTs cannot reliably differentiate germinomas from nongerminomatous germ cell tumors NGGCTs. The diagnosis of GCTs is based on the following:

• Clinical signs and symptoms
• Tumor markers (Alpha-fetoprotein (AFP) and beta subunit human chorionic gonadotropin (beta-HCG) in both serum and CSF, lumbar CSF cytology)
• Neuroimaging
• Cytological cerebrospinal fluid (CSF) and histological confirmation
• Magnetic resonance imaging (MRI) of brain and spine with gadolinium.
• Evaluation of pituitary/hypothalamic function.
• Visual-field examinations for suprasellar or hypothalamic tumors.
• A baseline neuropsychological examination when symptoms of endocrine deficiency and raised intracranial pressure are resolved.

HEENT

• Paralysis of upward gaze
• Pupils nonreactive to light perception and accommodation or pupils which react better to accommodation than light
• Nystagmus
• Failure of convergence
• Lid retraction
• Visual-field examinations
• Papilledema
• A baseline neuropsychological examination is also performed

Neuromuscular

• Patient is usually oriented to persons, place, and time: However, altered mental status may be present if there is increased intracranial pressure
• Clonus may be present
• Hyperreflexia / hyporeflexia / areflexia
• Positive Babinski / plantar reflex unilaterally/bilaterally
• Proximal/distal muscle weakness unilaterally/bilaterally
• Paralysis of upward gaze, failure of convergence, and pupils nonreactive to light perception and accommodation suggestive of cranial nerve II and III
• Unilateral/bilateral upper/lower extremity weakness
• Unilateral/bilateral sensory loss in the upper/lower extremity
• Ataxia
• Normal finger-to-nose test / Dysmetria
• Dysdiadochokinesia

References

Template:WikiDoc Sources