Uveal melanoma physical examination: Difference between revisions

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==Overview==
==Overview==
Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].
Patients with uveal melanoma usually appear normal. Physical examination of [[Patient|patients]] with uveal melanoma is usually remarkable for [[Ophthalmology|ophthalmologic]] findings of melanoma.
 
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 [disease name] is usually normal.
OR
Physical examination of patients with [disease name] is usually remarkable for [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].
===Appearance of the Patient===
===Appearance of the Patient===
*Patients with [disease name] usually appear [general appearance].  
*[[Patients]] with uveal melanoma usually appear normal.


===Vital Signs===
===Vital Signs===
 
*[[Patients]] with uveal melanoma usually present with normal [[vital signs]].
*High-grade / low-grade fever
*[[Hypothermia]] / hyperthermia may be present
*[[Tachycardia]] with regular pulse or (ir)regularly irregular pulse
*[[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]]


===Skin===
===Skin===
* Skin examination of patients with [disease name] is usually normal.
*[[Skin]] examination of [[patients]] with uveal melanoma is usually normal.<ref name="AlbertSearl1983">{{cite journal|last1=Albert|first1=Daniel M.|last2=Searl|first2=Steven S.|last3=Forget|first3=Bernadette|last4=Lavin|first4=Philip T.|last5=Kirkwood|first5=John|last6=Nordlund|first6=James J.|title=Uveal Findings in Patients with Cutaneous Melanoma|journal=American Journal of Ophthalmology|volume=95|issue=4|year=1983|pages=474–479|issn=00029394|doi=10.1016/0002-9394(83)90267-2}}</ref>
OR
*[[Cyanosis]]
*[[Jaundice]]
* [[Pallor]]
* Bruises


<gallery widths="150px">
*[[Skin]] [[nevus]] or melanoma


UploadedImage-01.jpg | Description {{dermref}}
===HEENT===
UploadedImage-02.jpg | Description {{dermref}}
 
</gallery>


===HEENT===
* Evidence of [[trauma]]
* HEENT examination of patients with [disease name] is usually normal.
*[[Pupils]] reactive to light and reactive to accommodation
OR
*Ophthalmoscopic exam may be abnormal with findings of :
* Abnormalities of the head/hair may include ___
**[[Iris]] [[melanoma]]:
* Evidence of trauma
***Circumscribed nodule mostly in the inferior half of the [[iris]]
* Icteric sclera
***Different in size
* [[Nystagmus]]  
***Yellow or brown in color
* Extra-ocular movements may be abnormal
**Chroidal [[melanoma]]:  
*Pupils non-reactive to light / non-reactive to accommodation / non-reactive to neither light nor accommodation
***Nodular [[mass]] under the [[Retinal pigment epithelium|retinal pigment]]
*Ophthalmoscopic exam may be abnormal with findings of ___
***Diffuse with less elevation
* Hearing acuity may be reduced
***Abnormal vascularization
*[[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".)
**[[Ciliary body]] melanoma:
*[[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".)
***Sentinel vessel
* [[Exudate]] from the ear canal
***Unilateral low [[intraocular pressure]]
* 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 uveal melanoma 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 [disease name] is usually normal.
*[[Pulmonary]] examination of patients with uveal melanoma 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 uveal melanoma 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 [disease name] is usually normal.
*[[Abdominal]] examination of patients with uveal melanoma is usually normal.
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 [disease name] is usually normal.
* Back examination of patients with uveal melanoma is usually normal.
OR
*Point tenderness over __ vertebrae (e.g. L3-L4)
*Sacral edema
*Costovertebral angle tenderness bilaterally/unilaterally
*Buffalo hump


===Genitourinary===
===Genitourinary===
* Genitourinary examination of patients with [disease name] is usually normal.
*[[Genitourinary]] examination of patients with uveal melanoma is usually normal.
OR
*A pelvic/adnexal mass may be palpated
*Inflamed mucosa
*Clear/(color), foul-smelling/odorless penile/vaginal discharge


===Neuromuscular===
===Neuromuscular===
* Neuromuscular examination of patients with [disease name] is usually normal.
*[[Neuromuscular]] examination of patients with uveal melanoma 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 [disease name] is usually normal.
*[[Extremities]] examination of patients with uveal melanoma 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==

Latest revision as of 03:35, 19 August 2019

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

Overview

Patients with uveal melanoma usually appear normal. Physical examination of patients with uveal melanoma is usually remarkable for ophthalmologic findings of melanoma.

Physical Examination

Appearance of the Patient

  • Patients with uveal melanoma usually appear normal.

Vital Signs

Skin

HEENT

  • Evidence of trauma
  • Pupils reactive to light and reactive to accommodation
  • Ophthalmoscopic exam may be abnormal with findings of :

Neck

  • Neck examination of patients with uveal melanoma is usually normal.

Lungs

  • Pulmonary examination of patients with uveal melanoma is usually normal.

Heart

  • Cardiovascular examination of patients with uveal melanoma is usually normal.

Abdomen

  • Abdominal examination of patients with uveal melanoma is usually normal.

Back

  • Back examination of patients with uveal melanoma is usually normal.

Genitourinary

  • Genitourinary examination of patients with uveal melanoma is usually normal.

Neuromuscular

  • Neuromuscular examination of patients with uveal melanoma is usually normal.

Extremities

  • Extremities examination of patients with uveal melanoma is usually normal.

References

  1. Albert, Daniel M.; Searl, Steven S.; Forget, Bernadette; Lavin, Philip T.; Kirkwood, John; Nordlund, James J. (1983). "Uveal Findings in Patients with Cutaneous Melanoma". American Journal of Ophthalmology. 95 (4): 474–479. doi:10.1016/0002-9394(83)90267-2. ISSN 0002-9394.

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