Ovarian germ cell tumor physical examination: Difference between revisions

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{{Ovarian germ cell tumor}}
{{Ovarian germ cell tumor}}
{{CMG}}; {{AE}} {{Sahar}}
{{CMG}}; {{AE}} {{Sahar}} {{MD}}
==Overview==
==Overview==
Patients with germ cells of the ovary usually appear normal. Physical examination of these patients is usually unremarkable and the tumors tend to be discovered incidentally or during imaging workups for another reason. When symptomatic, the physical examination may be remarkable for Abdominal/pelvic mass and/or signs of virilization, precocious puberty, and pregnancy depending on the capacity of the tumor for the production of hormones.
Patients with [[germ cells]] of the [[ovary]] usually appear normal. [[Physical examination]] of these patients is usually unremarkable and the [[tumors]] tend to be discovered incidentally or during [[imaging]] workups for another reason. When [[symptomatic]], the [[physical examination]] may be remarkable for [[Abdominal]]/[[pelvic]] [[mass]] and/or [[signs]] of [[virilization]], [[precocious puberty]], and [[pregnancy]] depending on the capacity of the [[tumor]] for the production of [[hormones]].
OR
Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].
OR
The presence of [finding(s)] on physical examination is diagnostic of [disease name].
OR
The presence of [finding(s)] on physical examination is highly suggestive of [disease name].
==Physical Examination==
==Physical Examination==
Physical examination of patients with germ cell tumors of the ovary is usually normal.
[[Physical examination]] of patients with [[germ cell]] [[tumors]] of the [[ovary]] is usually normal.
===Appearance of the Patient===
===Appearance of the Patient===
*Patients with germ cell tumors of the ovary usually appear normal.  
*Patients with [[germ cell]] [[tumors]] of the [[ovary]] usually appear normal.  
===Vital Signs===
===Vital Signs===
*High-grade / low-grade fever
*[[Fever]] is present in 10% to 25% of individuals with [[malignant]] [[ovarian]] [[germ cell]] [[tumors]].<ref name="Tewari2000">{{cite journal|last1=Tewari|first1=K|title=Malignant germ cell tumors of the ovary|journal=Obstetrics & Gynecology|volume=95|issue=1|year=2000|pages=128–133|issn=00297844|doi=10.1016/S0029-7844(99)00470-6}}</ref>
*[[Hypothermia]] / hyperthermia may be present
*[[Hypotension]] or [[shock]] may occur in case of spontaneous [[rupture]].<ref name="LowIlancheran2012">{{cite journal|last1=Low|first1=Jeffrey J.H.|last2=Ilancheran|first2=Arunachalam|last3=Ng|first3=Joseph S.|title=Malignant ovarian germ-cell tumours|journal=Best Practice & Research Clinical Obstetrics & Gynaecology|volume=26|issue=3|year=2012|pages=347–355|issn=15216934|doi=10.1016/j.bpobgyn.2012.01.002}}</ref>
*[[Tachycardia]] with regular pulse or (ir)regularly irregular pulse
**Spontaneous [[rupture]] may happen in <4% of affected individuals.
*[[Bradycardia]] with regular pulse or (ir)regularly irregular pulse
*Tachypnea / bradypnea
*Kussmal respirations may be present in _____ (advanced disease state)
*Weak/bounding pulse / pulsus alternans / paradoxical pulse / asymmetric pulse
*High/low blood pressure with normal pulse pressure / [[wide pulse pressure]] / [[narrow pulse pressure]]
*Hypotension or shock may occur in case of spontaneous rupture.<ref name="LowIlancheran2012">{{cite journal|last1=Low|first1=Jeffrey J.H.|last2=Ilancheran|first2=Arunachalam|last3=Ng|first3=Joseph S.|title=Malignant ovarian germ-cell tumours|journal=Best Practice & Research Clinical Obstetrics & Gynaecology|volume=26|issue=3|year=2012|pages=347–355|issn=15216934|doi=10.1016/j.bpobgyn.2012.01.002}}</ref>
**Spontaneous rupture may happen in <4% of affected individuals.


===Skin===
===Skin===
* Skin examination of patients with germ cell tumors of the ovary is usually normal.
* [[Skin]] [[examination]] of patients with [[germ cell]] [[tumors]] of the [[ovary]] is usually normal.
OR
*[[Cyanosis]]  
*[[Jaundice]]
* [[Pallor]]
* Bruises
===HEENT===
===HEENT===
* HEENT examination of patients with germ cell tumors of the ovary is usually normal.
* HEENT [[examination]] of patients with [[germ cell]] [[tumors]] of the [[ovary]] 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 germ cell tumors of the ovary is usually normal.
* [[Neck]] [[examination]] of patients with [[germ cell]] [[tumors]] of the [[ovary]] is usually normal.
OR
*[[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 germ cell tumors of the ovary is usually normal.
* [[Pulmonary examination]] of patients with [[germ cell]] [[tumors]] of the ovary is usually normal.
OR
* 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 [[ovarian]] [[germ cell]] [[tumors]] is usually normal.
OR
*Chest tenderness upon palpation
*PMI within 2 cm of the sternum  (PMI) / Displaced point of maximal impulse (PMI) suggestive of ____
*[[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===
* Abdominal examination of patients with germ cell tumors of the ovary may be remarkable for a mass or distention.<ref name="LowIlancheran2012">{{cite journal|last1=Low|first1=Jeffrey J.H.|last2=Ilancheran|first2=Arunachalam|last3=Ng|first3=Joseph S.|title=Malignant ovarian germ-cell tumours|journal=Best Practice & Research Clinical Obstetrics & Gynaecology|volume=26|issue=3|year=2012|pages=347–355|issn=15216934|doi=10.1016/j.bpobgyn.2012.01.002}}</ref>
* [[Abdominal examination]] of patients with [[germ cell]] [[tumors]] of the [[ovary]] may be remarkable for a [[mass]] or [[Abdominal distention|distention]].<ref name="LowIlancheran2012">{{cite journal|last1=Low|first1=Jeffrey J.H.|last2=Ilancheran|first2=Arunachalam|last3=Ng|first3=Joseph S.|title=Malignant ovarian germ-cell tumours|journal=Best Practice & Research Clinical Obstetrics & Gynaecology|volume=26|issue=3|year=2012|pages=347–355|issn=15216934|doi=10.1016/j.bpobgyn.2012.01.002}}</ref>
 
* [[Ascites]] can also be present.<ref name="Tewari2000">{{cite journal|last1=Tewari|first1=K|title=Malignant germ cell tumors of the ovary|journal=Obstetrics & Gynecology|volume=95|issue=1|year=2000|pages=128–133|issn=00297844|doi=10.1016/S0029-7844(99)00470-6}}</ref>
OR
*[[Abdominal distension]]  
*[[Abdominal tenderness]] in the right/left upper/lower abdominal quadrant
*[[Rebound tenderness]] (positive Blumberg sign)
*A palpable abdominal mass in the right/left upper/lower abdominal quadrant
*Guarding may be present
*[[Hepatomegaly]] / [[splenomegaly]] / [[hepatosplenomegaly]]
*Additional findings, such as obturator test, psoas test, McBurney point test, Murphy test


===Back===
===Back===
* Back examination of patients with germ cell tumors of the ovary is usually normal.
* Back [[examination]] of patients with [[germ cell]] [[tumors]] of the [[ovary]] is usually normal.
OR
*Point tenderness over __ vertebrae (e.g. L3-L4)
*Sacral edema
*Costovertebral angle tenderness bilaterally/unilaterally
*Buffalo hump
 
===Genitourinary===
===Genitourinary===
*A pelvic/adnexal mass may be palpated.<ref name="LowIlancheran2012">{{cite journal|last1=Low|first1=Jeffrey J.H.|last2=Ilancheran|first2=Arunachalam|last3=Ng|first3=Joseph S.|title=Malignant ovarian germ-cell tumours|journal=Best Practice & Research Clinical Obstetrics & Gynaecology|volume=26|issue=3|year=2012|pages=347–355|issn=15216934|doi=10.1016/j.bpobgyn.2012.01.002}}</ref>
*A [[pelvic]]/[[adnexal]] [[mass]] may be palpated.<ref name="LowIlancheran2012">{{cite journal|last1=Low|first1=Jeffrey J.H.|last2=Ilancheran|first2=Arunachalam|last3=Ng|first3=Joseph S.|title=Malignant ovarian germ-cell tumours|journal=Best Practice & Research Clinical Obstetrics & Gynaecology|volume=26|issue=3|year=2012|pages=347–355|issn=15216934|doi=10.1016/j.bpobgyn.2012.01.002}}</ref>
* Although rarely, mature teratoma may present as a vaginal mass.<ref name="VuralVural2015">{{cite journal|last1=Vural|first1=F.|last2=Vural|first2=B.|last3=Paksoy|first3=N.|title=Vaginal teratoma: A case report and review of the literature|journal=Journal of Obstetrics and Gynaecology|volume=35|issue=7|year=2015|pages=757–758|issn=0144-3615|doi=10.3109/01443615.2015.1004525}}</ref>
* Although rarely, [[Mature cystic teratoma|mature teratoma]] may present as a [[vaginal]] [[mass]].<ref name="VuralVural2015">{{cite journal|last1=Vural|first1=F.|last2=Vural|first2=B.|last3=Paksoy|first3=N.|title=Vaginal teratoma: A case report and review of the literature|journal=Journal of Obstetrics and Gynaecology|volume=35|issue=7|year=2015|pages=757–758|issn=0144-3615|doi=10.3109/01443615.2015.1004525}}</ref>
*Inflamed mucosa
*Clear/(color), foul-smelling/odorless penile/vaginal discharge


===Neuromuscular===
===Neuromuscular===
* Neuromuscular examination of patients with germ cell tumors of the ovary is usually normal.
* [[Neuromuscular]] [[examination]] of patients with [[ovarian]] [[germ cell]] [[tumors]] 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===
* Extremities examination of patients with germ cells of the ovary is usually normal.
* [[Extremities]] [[examination]] of patients with [[germ cells]] of the [[ovary]] is usually normal.
OR
*[[Clubbing]]
*[[Cyanosis]]
*Pitting/non-pitting [[edema]] of the upper/lower extremities
*Muscle atrophy
*Fasciculations in the upper/lower extremity
 
==References==
==References==
{{reflist|2}}
{{reflist|2}}

Latest revision as of 13:53, 22 April 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sahar Memar Montazerin, M.D.[2] Monalisa Dmello, M.B,B.S., M.D. [3]

Overview

Patients with germ cells of the ovary usually appear normal. Physical examination of these patients is usually unremarkable and the tumors tend to be discovered incidentally or during imaging workups for another reason. When symptomatic, the physical examination may be remarkable for Abdominal/pelvic mass and/or signs of virilization, precocious puberty, and pregnancy depending on the capacity of the tumor for the production of hormones.

Physical Examination

Physical examination of patients with germ cell tumors of the ovary is usually normal.

Appearance of the Patient

Vital Signs

Skin

HEENT

Neck

Lungs

Heart

Abdomen

Back

Genitourinary

Neuromuscular

Extremities

References

  1. ↑ 1.0 1.1 Tewari, K (2000). "Malignant germ cell tumors of the ovary". Obstetrics & Gynecology. 95 (1): 128–133. doi:10.1016/S0029-7844(99)00470-6. ISSN 0029-7844.
  2. ↑ 2.0 2.1 2.2 Low, Jeffrey J.H.; Ilancheran, Arunachalam; Ng, Joseph S. (2012). "Malignant ovarian germ-cell tumours". Best Practice & Research Clinical Obstetrics & Gynaecology. 26 (3): 347–355. doi:10.1016/j.bpobgyn.2012.01.002. ISSN 1521-6934.
  3. ↑ Vural, F.; Vural, B.; Paksoy, N. (2015). "Vaginal teratoma: A case report and review of the literature". Journal of Obstetrics and Gynaecology. 35 (7): 757–758. doi:10.3109/01443615.2015.1004525. ISSN 0144-3615.

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