Haematological Examination

General appearance Pt. lies flat, one pillow under head. Race, gender: Mediterranan descent (thalassemia). – African descent (sickle-cell anemia, SLE). – Northern European descent, blue eyes, premature grey hair (autoimmune disease: pernicious anemia). Colours: pale (anaemia), jaundice (haemolytic anaemia), bruising (thrombocytopoenia) Dyspnoea (anaemia, enlarged hylar lymph nodes)

Nails Nicotine stains. Koilonychia (iron deficiency). Pale nails (anemia). Splinter haemorrages (haemotological neoplasm)

Hands Pallor of palmar creases (anemia 2° to blood loss). Tophi (Gout 2° to myeloproliferative dz). Pulse: rate (anaemia has tachycardia), rhythm, character.

Arms Blood pressure. Scratch marks (lymphatic CA, myeloproliferative dz).

Trochlear Nodes Cup R hand below pt's R elbow. While holding pt's elbow, thumb reaches over pt's cubital fossa to palpate a spot anterior and proximal to pt's medial epicondyle. Palpate enlargement (drains the forearm)

Axillary Nodes Perform initially on both sides to compare If abnormality is found, perform separate examination noting (SHARP mnemonic) – Size: Pathologic nodes are generally greater than 1 cm – Hard: Firmness indicates malignancy – Amount: The greater the number of nodes felt, the more likely pathology exists – Relation to other nodes and surrounding tissue: Nodes fixed to each other or adjacent structures are worrisome for malignancy – Pain: Often associated with inflammation (e.g. infection)

Examine Waldeyer’s Ring Looking for enlargement and possible NH lymphoma Pharyngeal tonsil Tubal tonsil Palatine tonsils Lingual tonsils

Cervical and supraclavicular nodes

Particularly interested in the supraclavicular nodes Dx is Virchow's node, usually L one: Classically, stomach CA GI CA Pelvic CA Other CAs

Chest Trachea for deviation from nodes Assess bone pain (bone CA): Compress sternum with hands. Compress clavicle with hands. Tap spine with fist.

Abdomen Palpate along the abdominal aorta for grossly enlarged para-aortic nodes

Inguinal Nodes Palpate: Superficial inguinal and femoral nodes Deep inguinal Inguinal Node Examination

Popliteal Nodes

Legs examination Legs showing same symptoms as arms Ulcers. Peripheral neuropathy (Wernicke's encephalopathy 2° to B12 deficiency). Toenails and foot showing same symptoms as fingernails and hands