Hematological: Examination
  1. Environment, general appearance
  2. Nails, hands, arms
  3. Trochlear, axillary nodes
  4. Eyes, mouth
  5. Cervical, supraclavicular nodes
  6. Chest, abdomen
  7. Abdominal nodes
  8. Inguinal nodes
  9. Legs
Environment
  • Sterile room (infections).
General appearance
  • Pt. lies flat, one pillow under head.
  • Race, gender:
    Mediterranean descent (thalassemia).
    African descent (sickle-cell anemia).
    African descent female (SLE).
    Female (Felty's)
    Northern European descent, blue eyes, premature gray hair (pernicious anemia).
  • Colors: pale (anemia), jaundice (hemolytic anemia). See Skin Colors Reference.
  • Dyspnea, wheeze, difficulties.
  • Bruising.
  • RA posture (Felty's).
  • AIDS features.
  • Ask pt. if tenderness anywhere, so do not overpalpate painful nodes.
Nails
  • Nicotine stains.
  • Koilonychia (iron deficiency).
  • Pale nails (anemia).
  • See Nails Reference.
Hands
  • Pallor of palmar creases (anemia 2 to blood loss).
  • RA joints (Felty's).
  • Tophi (Gout 2 to myeloproliferative dz).
  • Connective tissue dz's (anemia 2 to inflammation).
  • Noticeable heat (infections).
  • Pulse: rate (anemia has tachycardia), rhythm, character.
Arms
  • Blood pressure.
  • Scratch marks (lymphatic CA, myeloproliferative dz).
  • Palpable purpura (dysglobulinema).
Trochlear nodes
  • Cup Dr's R hand below pt's R elbow.
  • While holding pt's elbow, Dr's thumb reaches over pt's cubital fossa to palpate a spot anterior and proximal to pt's medial epicondyle.
  • Palpate enlargement. See Nodes Reference.
Axillary nodes
  • Pt raises arm over head.
  • Dr's L fingers insert deeply into pt's R axilla.
  • Pt's elbow is bent, so forearm rests on Dr's forearm during palpation.
  • Palpate enlargement of all nodes. See Nodes Reference.
Eyes
  • Conjunctiva: pale (anemia).
  • Sclera: jaundice (hemolytic anemia), hemorrhages (polycythemia).
  • Eye fundus:
    Papilloedema (macroglobulinemia, etc).
    AIDS ocular lesions (toxoplasmosis, CMV).
    Hemorrhages.
    See Fundus Examination.
Mouth
  • Gum hypertrophy (leukemia).
  • Gum bleeding.
  • Scurvy (Vit C. deficiency so might be others).
  • Tongue: glossitis (iron deficiency, megaloblastic anemia).
  • Waldeyer's ring inflammation (non-Hodgkin's).
Cervical, supraclavicular nodes
  • Pt sits up.
  • Dr. examines from behind pt.
  • Palpate nodes in order:
    Submental
    Submandibular
    Deep cervical
    Preauricular
    Postauricular
    Occipital (classically Rubella)
    Supraclavicular
    Infraclavicular
    Posterior triangle
  • See Nodes Reference.
Chest
  • Trachea for deviation from nodes. See Trachea Examination.
  • Assess bone pain (bone CA):
    Compress sternum with hands.
    Compress clavicle with hands.
    Tap spine with fist.
Abdomen
Abdominal nodes
Inguinal nodes
  • Palpate nodes:
    Superficial inguinal: superior, horizontal, inferior groups
    Deep inguinal
  • See Nodes Reference.
Legs
  • Legs showing same symptoms as Arms.
  • Ulcers.
  • Foot drop (anemia 2 to lead poisoning).
  • Peripheral neuropathy (Wernicke's encephalopathy 2 to B12 deficiency).
  • Popliteal node if possible (heel lesions). See Nodes Reference.
  • Toenails and foot showing same symptoms as Fingernails and Hands.