Mycosis fungoides physical examination: Difference between revisions

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__NOTOC__
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{{Cutaneous T cell lymphoma}}
{{Mycosis fungoides}}
{{CMG}}; {{AE}} {{AS}} {{JH}}
{{CMG}}; {{AE}} {{S.G.}}
==Overview==
==Overview==
Common physical examination findings of cutaneous T cell lymphoma include [[fever]], [[rash]], [[pruritus]], [[ulcer]], chest tenderness, abdomen tenderness, bone tenderness, [[Lymphadenopathy|peripheral lymphadenopathy]], and [[Lymphadenopathy|central lymphadenopathy]].
Common [[physical examination]] findings of [[cutaneous T cell lymphoma]] include [[fever]], [[rash]], [[pruritus]], [[ulcer]], [[chest]] [[tenderness]], [[abdomen]] [[tenderness]], [[bone]] [[tenderness]], [[Lymphadenopathy|peripheral lymphadenopathy]], and [[Lymphadenopathy|central lymphadenopathy]].
==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].
 
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===
*Patients with [disease name] usually appear [general appearance].
===Vital Signs===
===Vital Signs===


*High-grade / low-grade fever
*[[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 [[Patient|patients]] with mycosis fungoides should be done generally.
OR
* [[Skin]] lesions and [[lymphadenopathy]] should be observed and monitor  their changes.
*[[Cyanosis]]  
*[[Jaundice]]
* [[Pallor]]
* Bruises
 
<gallery widths="150px">


UploadedImage-01.jpg | Description {{dermref}}
**[[Skin lesion|Skin lesions]]
UploadedImage-02.jpg | Description {{dermref}}
**[[Enlarged lymph nodes]]
 
**[[Fingernails]] and [[toenails]] [[abnormalities]]
</gallery>
**lower [[Eyelid|eyelides]]
**[[trouble]] regulating [[body temperature]]
**[[Splenomegaly]]
**[[Hepatomegaly]]
**[[Gastrointestinal tract|Gastrointestinal trac]]


===HEENT===
===HEENT===
* HEENT examination of patients with [disease name] is usually normal.
* HEENT examination of patients with mycosis fungoides 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 mycosis fungoides 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 mycosis fungoides  is usually normal.
OR
* Pulmonary function tests and comprehensive metabolic panel (including liver and kidney function) should be monitored during treatment with methotrexate.
* 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 mycosis fungoides 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 mycosis fungoides  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 mycosis fungoides 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 mycosis fungoides  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 mycosis fungoides  is usually normal
OR
===Extremities===
*Patient is usually oriented to persons, place, and time
* Extremities examination of patients with mycosis fungoides  is usually normal.
* 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 [disease name] is usually normal.
OR
*[[Clubbing]]  
*[[Clubbing]]  
*[[Cyanosis]]  
*[[Cyanosis]]  
*Pitting/non-pitting [[edema]] of the upper/lower extremities
*[[Pitting edema|Pitting]]/non-[[Pitting edema|pitting]] [[edema]] of the upper/lower [[extremities]]
*Muscle atrophy
*[[Muscle]] [[atrophy]]
*Fasciculations in the upper/lower extremity
*[[Fasciculation|Fasciculations]] in the upper/lower [[extremities]]


==References==
==References==
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{{WH}}
{{WH}}
{{WS}}
{{WS}}
[[Category: (name of the system)]]==Physical Examination<ref name="seer.cancer">Cutaneous T cell lymphoma. Surveillance, Epidemiology, and End Results . http://seer.cancer.gov/seertools/hemelymph/51f6cf56e3e27c3994bd52f7/ Accessed on January 19, 2016</ref>==
[[Category: (name of the system)]]
==Physical Examination<ref name="seer.cancer">Cutaneous T cell lymphoma. Surveillance, Epidemiology, and End Results . http://seer.cancer.gov/seertools/hemelymph/51f6cf56e3e27c3994bd52f7/ Accessed on January 19, 2016</ref><nowiki>==</nowiki>
===Vital Signs===
===Vital Signs===
* [[Fever]] is often present<ref name="seer.cancer" />  
* [[Fever]] is often present<ref name="seer.cancer" />  

Latest revision as of 19:10, 3 January 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sogand Goudarzi, MD [2]

Overview

Common physical examination findings of cutaneous T cell lymphoma include fever, rash, pruritus, ulcer, chest tenderness, abdomen tenderness, bone tenderness, peripheral lymphadenopathy, and central lymphadenopathy.

Physical Examination

Vital Signs

Skin

HEENT

  • HEENT examination of patients with mycosis fungoides is usually normal.

Neck

  • Neck examination of patients with mycosis fungoides is usually normal.

Lungs

  • Pulmonary examination of patients with mycosis fungoides is usually normal.
  • Pulmonary function tests and comprehensive metabolic panel (including liver and kidney function) should be monitored during treatment with methotrexate.

Heart

  • Cardiovascular examination of patients with mycosis fungoides is usually normal.

Abdomen

  • Abdominal examination of patients with mycosis fungoides is usually normal.

Back

  • Back examination of patients with mycosis fungoides is usually normal.

Genitourinary

  • Genitourinary examination of patients with mycosis fungoides is usually normal.

Neuromuscular

  • Neuromuscular examination of patients with mycosis fungoides is usually normal

Extremities

  • Extremities examination of patients with mycosis fungoides is usually normal.

References

Template:WH Template:WS ==Physical Examination[1]==

Vital Signs

HEENT

Chest Exam

Skin

Abdomen

Extremities

Cutaneous T cell lymphoma skin manifestations[2]
Name Description
Premycotic (pretumor) phase
  • Small, scaly, red rashes or patches on the skin
  • Rashes can appear anywhere on the body, in areas that are not exposed to the sun
  • Does not cause symptoms and may last for months or years
Patch phase
  • Flat, thin, red patches or eczema-like rash on the skin
Plaque phase
  • Raised red patches (plaques) on the skin
Tumor phase
  • Lumps or nodules (tumours) on the skin
  • Tumors can cause open areas (ulcers), which can become infected

References

  1. ↑ 1.0 1.1 Cutaneous T cell lymphoma. Surveillance, Epidemiology, and End Results . http://seer.cancer.gov/seertools/hemelymph/51f6cf56e3e27c3994bd52f7/ Accessed on January 19, 2016
  2. ↑ Cutaneous T cell lymphoma. Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/non-hodgkin-lymphoma/non-hodgkin-lymphoma/types-of-nhl/cutaneous-t-cell-lymphoma/?region=on Accessed on January 19, 2016


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