Small cell carcinoma of the lung physical examination: Difference between revisions

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(/* Physical Examination{{cite journal| author=Spiro SG, Gould MK, Colice GL, American College of Chest Physicians| title=Initial evaluation of the patient with lung cancer: symptoms, signs, laboratory tests, and paraneoplastic syndromes: ACCP evidenced...)
(/* Physical Examination{{cite journal| author=Spiro SG, Gould MK, Colice GL, American College of Chest Physicians| title=Initial evaluation of the patient with lung cancer: symptoms, signs, laboratory tests, and paraneoplastic syndromes: ACCP evidenced...)
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==Physical Examination<ref name="pmid17873166">{{cite journal| author=Spiro SG, Gould MK, Colice GL, American College of Chest Physicians| title=Initial evaluation of the patient with lung cancer: symptoms, signs, laboratory tests, and paraneoplastic syndromes: ACCP evidenced-based clinical practice guidelines (2nd edition). | journal=Chest | year= 2007 | volume= 132 | issue= 3 Suppl | pages= 149S-160S | pmid=17873166 | doi=10.1378/chest.07-1358 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17873166  }} </ref><ref name="pmid21565397">{{cite journal| author=van Meerbeeck JP, Fennell DA, De Ruysscher DK| title=Small-cell lung cancer. | journal=Lancet | year= 2011 | volume= 378 | issue= 9804 | pages= 1741-55 | pmid=21565397 | doi=10.1016/S0140-6736(11)60165-7 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21565397  }} </ref><ref name="pmid18316005">{{cite journal| author=Sher T, Dy GK, Adjei AA| title=Small cell lung cancer. | journal=Mayo Clin Proc | year= 2008 | volume= 83 | issue= 3 | pages= 355-67 | pmid=18316005 | doi=10.4065/83.3.355 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18316005  }} </ref>==
==Physical Examination<ref name="pmid17873166">{{cite journal| author=Spiro SG, Gould MK, Colice GL, American College of Chest Physicians| title=Initial evaluation of the patient with lung cancer: symptoms, signs, laboratory tests, and paraneoplastic syndromes: ACCP evidenced-based clinical practice guidelines (2nd edition). | journal=Chest | year= 2007 | volume= 132 | issue= 3 Suppl | pages= 149S-160S | pmid=17873166 | doi=10.1378/chest.07-1358 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17873166  }} </ref><ref name="pmid21565397">{{cite journal| author=van Meerbeeck JP, Fennell DA, De Ruysscher DK| title=Small-cell lung cancer. | journal=Lancet | year= 2011 | volume= 378 | issue= 9804 | pages= 1741-55 | pmid=21565397 | doi=10.1016/S0140-6736(11)60165-7 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21565397  }} </ref><ref name="pmid18316005">{{cite journal| author=Sher T, Dy GK, Adjei AA| title=Small cell lung cancer. | journal=Mayo Clin Proc | year= 2008 | volume= 83 | issue= 3 | pages= 355-67 | pmid=18316005 | doi=10.4065/83.3.355 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18316005  }} </ref>==


===Vital signs===
===Vital Signs===
*[[Fever]]: up to 20% of patients with [[lung cancer]]
*[[Fever]] (in up to 20% of patients with [[lung cancer]])


*[[Hypertension]]: [[Cushing's syndrome]]  
*[[Hypertension]] (can be present in case of [[Cushing's syndrome]])


===General appearance===
===General Appearance===
*[[Cachexic]]: [[weight loss]] and [[anorexia]]
*[[Cachexia]] ([[weight loss]] and [[anorexia]])
*[[Jaundice]]: liver metastases
*[[Jaundice]] (suggestive of liver [[metastasis]])
*[[Pale skin]] and conjunctiva: [[anemia of chronic disease]].
*[[Pale skin]] (suggestive of [[anemia of chronic disease]])
*[[Cyanotic]]: [[dyspnea]]
*[[Cyanosis]] (suggestive of severe [[dyspnea]])
*[[Lymphadenopathy]] (> 1 cm)
*[[Lymphadenopathy]] (> 1 cm)
*Soft tissue mass
<div align="left">
<gallery heights="145" widths="375">
Image:Cachexia.jpg|Cachexia
</gallery>
</div>


===HEENT===
===HEENT===


====Head====
====Head====
*Moon facies: [[Cushing's syndrome]]
*Moon facies (suggestive of [[Cushing's syndrome]])


====Eyes====
====Eyes====
*[[Jaundice]]: liver [[metastases]] OR
* Yellow discoloration of the [[sclera]] (suggestive of [[jaundice]] due to liver [[metastasis]])
*Conjunctival [[pallor]]: [[anemia of chronic disease]]
* Conjunctival [[pallor]] (suggestive of [[anemia of chronic disease]])
*[[Miosis]], ipsilateral [[ptosis]] and lack of facial sweating: [[Horner's syndrome]]
*[[Miosis]], ipsilateral [[ptosis]] and lack of facial sweating (suggestive of [[Horner's syndrome]])


====Throat====
Shown below is an image depicting ptosis in a patient with [[Horner's syndrome]].
*[[Hoarseness]]: [[superior vena cava syndrome]]


<div align="left">
<div align="left">
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</gallery>
</gallery>
</div>
</div>
====Throat====
*[[Hoarseness]] ( suggestive of compression of the [[recurrent laryngeal nerve]])


===Lungs===
===Lungs===
*Unilateral [[wheeze]]
* unilateral decreased air entry
*[[Pleural effusion]]
* Unilateral [[wheeze]]
* Decreased air entry in the bases of the lungs and/or [[crackles]] (suggestive of [[Pleural effusion]])


===Abdomen===
===Abdomen===
*[[Hepatomegaly]] (> 13 cm span): [[liver]] [[metastases]]
*[[Hepatomegaly]] (> 13 cm span) (suggestive of liver [[metastasis]])


===Musculoskeletal system===
===Musculoskeletal system===
*[[Digital clubbing]]
*[[Digital clubbing]]
*[[Bone]] [[tenderness]]: [[bone]] [[metastases]]
*[[Bone]] [[tenderness]] (suggestive of [[bone]] [[metastasis]])
*[[Osteoarthropathy]]: painful symmetrical arthropathy of the knees, wrist, and knees, and periosteal new [[bone]] formation.
*[[Osteoarthropathy]]: painful symmetrical arthropathy of the knees, wrist, and knees, and periosteal new [[bone]] formation.
Shown below is an image depicting [[digital clubbing]].


<div align="left">
<div align="left">
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===Neurological===
===Neurological===
A complete neurological exam should be performed.
*[[Ataxia]], [[dysarthria]], [[nystagmus]] and sever [[vertigo]]: cerebellar degeneration
*[[Ataxia]], [[dysarthria]], [[nystagmus]] and sever [[vertigo]]: cerebellar degeneration
*Proximal muscles of lower extremities [[weakness]] and fatiguability, abnormal [[gait]], [[hyporeflexia]], increased [[deep-tendon reflexes]] after facilitation, [[autonomic dysfunction]], and [[paresthesias]]
*Proximal muscles of lower extremities [[weakness]] and fatiguability, abnormal [[gait]], [[hyporeflexia]], increased [[deep-tendon reflexes]] after facilitation, [[autonomic dysfunction]], and [[paresthesias]]


===Skin===
===Skin===
*Acquired [[Tylosis]]
*Acquired [[tylosis]]
*Trip palms
*Trip palms
*[[Erythema]] gyratum repens
*[[Erythema]] gyratum repens

Revision as of 15:19, 19 June 2014

Small Cell Carcinoma of the Lung Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editors-in-Chief: Guillermo Rodriguez Nava, M.D. [2]

Overview

Many authors have concluded that performing a complete assessment, with a detailed history and physical examination, is useful for identifying patients with a higher likelihood of metastases.[1]

Physical Examination[1][2][3]

Vital Signs

General Appearance

HEENT

Head

Eyes

Shown below is an image depicting ptosis in a patient with Horner's syndrome.

  • Horner's Syndrome

    Horner's Syndrome

Throat

Lungs

Abdomen

Musculoskeletal system

Shown below is an image depicting digital clubbing.

  • Clubbing

    Clubbing

  • Clubbing

    Clubbing

Neurological

A complete neurological exam should be performed.

Skin

References

  1. ↑ 1.0 1.1 Spiro SG, Gould MK, Colice GL, American College of Chest Physicians (2007). "Initial evaluation of the patient with lung cancer: symptoms, signs, laboratory tests, and paraneoplastic syndromes: ACCP evidenced-based clinical practice guidelines (2nd edition)". Chest. 132 (3 Suppl): 149S–160S. doi:10.1378/chest.07-1358. PMID 17873166.
  2. ↑ van Meerbeeck JP, Fennell DA, De Ruysscher DK (2011). "Small-cell lung cancer". Lancet. 378 (9804): 1741–55. doi:10.1016/S0140-6736(11)60165-7. PMID 21565397.
  3. ↑ Sher T, Dy GK, Adjei AA (2008). "Small cell lung cancer". Mayo Clin Proc. 83 (3): 355–67. doi:10.4065/83.3.355. PMID 18316005.

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