Multiple myeloma physical examination: Difference between revisions

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Latest revision as of 22:47, 29 July 2020

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Hannan Javed, M.D.[2]; Haytham Allaham, M.D. [3]; Shyam Patel [4]

Overview

Patients with multiple myeloma usually appear fatigued and lethargic. Physical examination of patients with multiple myeloma is usually remarkable for pallor, purpura, hepatosplenomegaly, bony tenderness, carpal tunnel syndrome, and signs of cord compression. Any of these physical findings may warrant further evaluation, and thus lead to an incidental diagnosis of multiple myeloma.^[1]^[2]

Physical Examination

General appearance

Multiple myeloma patients often appear lethargic and fatigued

Vital Signs

Low-grade fever may be present

Skin

HEENT

Lymphadenopathy
Conjuctival pallor
Visual defects
Exudative retinal detachment
Retinal haemorrhage
Increased adipose deposition around the neck (if dexamethasone is used for therapy)
Cotton-wool spots may be present

Abdomen

Hepatomegaly
Splenomegaly
Abdominal tenderness (if hypercalcemia is present)

Skeletal

Bony tenderness along cervical, thoracic, and lumbar spine
Bony tenderness in long bones
Tinel's sign may be present
Phalen sign may be present

Neurologic

Dermatomal sensory loss
Altered sensation
Neuropathy

Psychiatric

Mood alterations (if hypercalcemia is present)

References

↑ Multiple myeloma. Wikipedia (2015) https://en.wikipedia.org/wiki/Multiple_myeloma#Signs_and_symptoms Accessed on September, 20th 2015
↑ Multiple myeloma. Canadian Cancer Society (2015) http://www.cancer.ca/en/cancer-information/cancer-type/multiple-myeloma/signs-and-symptoms/?region=mb Accessed on September 20th 2015

[N-1] Multiple myeloma. Wikipedia (2015) https://en.wikipedia.org/wiki/Multiple_myeloma#Signs_and_symptoms Accessed on September, 20th 2015

[C-2] Multiple myeloma. Canadian Cancer Society (2015) http://www.cancer.ca/en/cancer-information/cancer-type/multiple-myeloma/signs-and-symptoms/?region=mb Accessed on September 20th 2015

[1]

[2]

@@ Line 1: / Line 1: @@
 __NOTOC__
 {{Multiple myeloma}}
-{{CMG}}
+{{CMG}} {{AE}} {{HMHJ}}; {{HL}}; {{shyam}}
 ==Overview==
-Multiple myeloma affects not only the bone marrow, but also spreads to other organ systems. This therefore, requires a detailed assessment of various organ systems. A number of times, any of these physical findings may warrant a further evaluation, and thus leads to an incidental diagnosis of multiple myeloma. [[Pallor]], [[purpura]], signs of [[cord compression]], [[hepatosplenomegaly]], bony pain without tenderness and [[carpal tunnel syndrome]] are some of the most common physical findings, in a patient presenting with multiple myeloma.
+[[Patients]] with [[multiple myeloma]] usually appear [[Fatigue|fatigued]] and [[lethargic]]. Physical examination of [[patients]] with [[multiple myeloma]] is usually remarkable for [[pallor]], [[purpura]], [[hepatosplenomegaly]], bony [[tenderness]], [[carpal tunnel syndrome]],  and [[signs]] of [[cord compression]]. Any of these physical findings may warrant further evaluation, and thus lead to an incidental [[diagnosis]] of [[multiple myeloma]].<ref name="N">Multiple myeloma. Wikipedia (2015) https://en.wikipedia.org/wiki/Multiple_myeloma#Signs_and_symptoms Accessed on September, 20th 2015</ref><ref name="C">Multiple myeloma. Canadian Cancer Society (2015) http://www.cancer.ca/en/cancer-information/cancer-type/multiple-myeloma/signs-and-symptoms/?region=mb Accessed on September 20th 2015</ref>
 ==Physical Examination==
-'''Head, ears, eyes, nose, and throat (HEENT) examination:''' [[Pallor]] is one of the most evident physical findings associated with multiple myeloma. Additionally eyes may show exudative macular detachment, [[retinal haemorrhage]], or [[cotton-wool spot|cotton-wool spots]].
+===General appearance===
+*[[Multiple myeloma]] patients often appear [[lethargic]] and [[Fatigue|fatigued]]
-'''Skin:''' [[Ecchymoses]] or [[purpura]] from [[thrombocytopenia]] may be evident.
+===Vital Signs===
+*Low-grade [[fever]] may be present
-'''Central nervous system:''' It includes altered sensations, dermatomal sensory loss resulting from [[cord compression]] and neuropathy, myopathy, a [[Tinel's sign]], or a [[Phalen's maneuver|Phalen sign]] due to [[carpal tunnel syndrome|carpal tunnel compression]] secondary to [[amyloid]] deposition.
+===Skin===
+*[[Pallor]]
+*[[Ecchymoses]]
+*[[Purpura]]
-'''Gastrointestinal system:''' [[Hepatosplenomegaly]]
+===HEENT===
+*[[Lymphadenopathy]]
+*[[Conjuctiva|Conjuctival]] [[pallor]]
+*[[Visual]] defects
+*[[Exudative]] [[retinal]] detachment
+*[[Retinal haemorrhage]]
+*Increased [[adipose]] deposition around the [[neck]] (if [[dexamethasone]] is used for therapy)
+*[[Cotton-wool spots]] may be present
-'''Cardiovascular system:''' [[Cardiomyopathy]] from plasma protein deposition.
+===Abdomen===
+*[[Hepatomegaly]]
+*[[Splenomegaly]]
+*Abdominal tenderness (if hypercalcemia is present)
-'''Bony and muscular system:''' Pain without tenderness is a feature highly specific for multiple myeloma, though not diagnostic. Pathological fractures are also pretty common.
+===Skeletal===
+*Bony [[tenderness]] along [[cervical]], [[thoracic]], and [[lumbar]] [[spine]]
+*Bony [[tenderness]] in long [[bones]]
+*[[Tinel's sign]] may be present
+*[[Phalen's maneuver|Phalen sign]] may be present
-[[Plasmacytoma|Extramedullary plasmacytomas]], which consist of soft-tissue masses of plasma cells, are not uncommon.
+===Neurologic===
+*Dermatomal [[sensory loss]]
+*Altered [[sensation]]
+*[[Neuropathy]]
-'''Amyloidosis''' may develop in some patients with MM. The characteristic physical examination findings that suggest amyloidosis include the following:
+===Psychiatric===
-:* Shoulder pad sign - Fat deposition around shoulders.
+*Mood alterations (if [[hypercalcemia]] is present)
-:* [[Macroglossia]]
+==References==
-:* [[Purpura]]
+{{Reflist|2}}
-:* [[Carpal tunnel syndrome]]
-== References ==
+[[Category:Medicine]]
-{{reflist|2}}
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+[[Category:Neurology]]
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+[[Category:Neurosurgery]]
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