CONFIRMING DIAGNOSIS Typical clinical findings and bone marrow aspirate showing a proliferation of immature WBCs confirm acute leukemia.
A bone marrow biopsy, usually of the posterior superior iliac spine, is part of the diagnostic workup. Blood counts show thrombocytopenia and neutropenia. Differential leukocyte count determines cell type. Lumbar puncture detects meningeal involvement.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Chronic lymphocytic leukemia:
Diagnosis
(Professional Guide to Diseases (Eighth Edition))
Typically, CLL is an incidental finding during a routine blood test that reveals numerous abnormal lymphocytes. In early stages, white blood cell (WBC) count is mildly but persistently elevated. Granulocytopenia is the rule, but the WBC count climbs as the disease progresses. Blood studies also show hemoglobin levels under 11 g, hypogammaglobulinemia, and depressed serum globulins. Other common developments include neutropenia (neutrophils less than 1,500/µl), lymphocytosis (lymphocytes more than 10,000/µl), and thrombocytopenia (platelets less than 150,000/µl). Bone marrow aspiration and biopsy show lymphocytic invasion.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Seizures, generalized tonic-clonic:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
If you didn’t witness the seizure, obtain a description from the patient’s companion. Ask when the seizure started and how long it lasted. Did the patient report any unusual sensations before the seizure began? Did the seizure start in one area of the body and spread, or did it affect the entire body right away? Did the patient fall on a hard surface? Did his eyes or head turn? Did he turn blue? Did he lose bladder control? Did he have any other seizures before recovering?
If the patient may have sustained a head injury, observe him closely for loss of consciousness, unequal or nonreactive pupils, and focal neurologic signs. Does he complain of headache and muscle soreness? Is he increasingly difficult to arouse when you check on him at 20-minute intervals? Examine his arms, legs, and face (including tongue) for injury, residual paralysis, or limb weakness.
Next, obtain a history. Has the patient ever had generalized or focal seizures before? If so, do they occur frequently? Do other family members also have them? Is the patient receiving drug therapy? Is he compliant? Ask about sleep deprivation and emotional or physical stress at the time the seizure occurred.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Lymphadenopathy, Generalized:
History
(The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
should focus on those common causes of generalized lymphadenopathy.
A. History of present illness should focus on the duration, location, quality, and context of the lymphadenopathy. Note associated signs and symptoms such as rash, fever, sore throat, and cough (4) (Chapters 2.6, 8.1, and 13.6). The goal is to ascertain if the adenopathy is attributable to a specific cause.
B. Past medical history should focus on known illness, medication usage, and allergies. Serum sickness from antibiotic use as well as diphenylhydantoin for seizure prevention can cause generalized lymphadenopathy. Common chronic illnesses (e.g., lupus erythematosus and rheumatoid arthritis) can also cause generalized lymphadenopathy.
C. Social history should focus on the patient’s occupation, sexual history, and alcohol use. Hepatitis B, secondary syphilis, and early human immunodeficiency virus (HIV) can all present with generalized lymphadenopathy. Patients with Hodgkin’s disease can develop painful adenopathy with alcohol use.
D. Family history. Inquire about family illness with a genetic predisposition as well as any exposures to household contacts with infectious diseases (e.g., tuberculosis, infectious mononucleosis, or hepatitis B).
E. Review of systems should focus on constitutional symptoms such as weight loss, fatigue, night sweats, malaise, arthralgias, nausea, and vomiting (1).
Physical examination
A. General. A comprehensive physical examination should be performed on all patients with generalized lymphadenopathy. Focus on those findings consistent with the most frequent causes of generalized lymphadenopathy. Note the patient’s temperature and weight, because fever and weight loss are frequent findings. Examine the skin, mucous membranes, abdominal organs, and joints; specifically, the presence of rash, mucocutaneous ulceration, organomegaly, and arthritis can be a guide to possible causes of the adenopathy. The presence of splenomegaly in a patient with adenopathy implies a systemic illness (e.g., infectious mononucleosis, lymphoma, leukemia, lupus, sarcoidosis, toxoplasmosis, or cat scratch disease) (Chapter 15.4). Additionally, search for other abnormal lymph nodes. Studies have shown that clinicians identified only 17% of those cases of generalized lymphadenopathy when it was present (1).
B. Nodal examination. The abnormal lymph node groups should be specifically examined.
1. Size. Lymph nodes enlarged up to 1 cm in diameter can be considered normal in size. These have a low malignancy risk and can usually be observed. Lymph nodes greater than 1.5 cm × 1.5 cm in area have been shown to have a 38% risk of cancer involvement and merit further workup (2).
2. Location. Anterior cervical, submandibular, and inguinal nodes are normally palpable. The presence of supraclavicular adenopathy is always abnormal and carries a 90% cancer risk in those aged more than 40 years. Postocciptal nodes are associated with infectious mononucleosis, scalp lesions, toxoplasmosis, and non-Hodgkin’s lymphoma. Axillary nodes are associated with upper extremity infections, breast cancer, cat scratch disease, and lymphomas. Epitrochlear nodes are associated with pyogenic infections, sarcoidosis, tularemia, and syphilis. Inguinal nodes are associated with lower extremity infections and sexually transmitted diseases.
3. Pain. The presence or absence of pain is not a reliable indicator of the cause of adenopathy. Capsular swelling from acute infections can cause pain as can necrotic hemorrhage from a malignant lymph node.
4. Consistency. Rock hard nodes are consistent with metastatic disease (2). Firm rubbery nodes are found with lymphomas. Soft nodes tend to occur with infectious causes; however, this should not be considered diagnostic.
» READ BOOK EXCERPT ONLINE »
Source: The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter, 2000
Leukemia, acute:
Diagnosis
(Handbook of Diseases)
Typical signs and symptoms and bone marrow aspirate showing a proliferation of immature WBCs confirm acute leukemia. An aspirate that’s dry or free from leukemic cells in a patient with typical signs and symptoms requires a bone marrow biopsy, usually of the posterior superior iliac spine.
Blood counts show thrombocytopenia and neutropenia. A differential leukocyte count determines cell type. Lumbar puncture detects meningeal involvement.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Leukemia, chronic lymphocytic:
Diagnosis
(Handbook of Diseases)
Typically, chronic lymphocytic leukemia is an incidental finding during a routine blood test that reveals numerous abnormal lymphocytes. In early stages, the white blood cell (WBC) count is mildly but persistently elevated. Granulocytopenia is the rule, but the WBC count climbs as the disease progresses.
Blood studies also show a hemoglobin level below 11 g, hypogammaglobulinemia, and depressed serum globulin levels. Other common findings include neutropenia (less than 1,500/µl), lymphocytosis (more than 10,000/µl), and thrombocytopenia (less than 150,000/µl). Bone marrow aspiration and biopsy show lymphocytic invasion.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Leukemia, chronic granulocytic:
Diagnosis
(Handbook of Diseases)
In patients with typical signs and symptoms, chromosomal analysis of peripheral blood or bone marrow showing Ph1 and low leukocyte alkaline phosphatase levels confirms CGL. Other relevant laboratory results include:
❑ white blood cell abnormalities: leukocytosis (leukocyte count ranging from 50,000/µl to 250,000/µl), occasional leukopenia (leukocyte count less than 5,000/µl), neutropenia (neutrophil count less than 1,500/µl) despite a high leukocyte count, and increased circulating myeloblasts
❑ hemoglobin level: commonly below 10 g/dl
❑ hematocrit: low (less than 30%)
❑ platelet count: thrombocytosis (more than 1 million/µl) common
❑ serum uric acid level: possibly more than 8 mg/dl
❑ bone marrow aspirate or biopsy: hypercellular, characteristically shows bone marrow infiltration by significantly increased number of myeloid elements (a biopsy is done only if aspirate is dry); in the acute phase, myeloblasts predominate
❑ computed tomography scan: may identify the organs affected by leukemia.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Seizures, generalized tonic-clonic:
History
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
Obtain the patient’s medical history. Has he had generalized or focal seizures before? If so, how frequently? Do other family members have seizures? Is the patient receiving drug therapy? Is he compliant? Ask about sleep deprivation and emotional or physical stress at the time the seizure occurred. Ask about the use of alcohol or illicit drugs.
If you didn’t witness the seizure, obtain a description from the patient’s family. Ask when it started and how long it lasted. Did the patient report unusual sensations before the seizure began? Did the seizure start in one area of the body and spread, or did it affect the entire body immediately? Did the patient fall on a hard surface? Did his eyes or head turn? Did he turn blue? Did he lose bladder control? Did he have other seizures before recovering? Does he complain of headache and muscle soreness?
Physical examination
If the patient may have sustained a head injury, perform a complete neurologic examination, observing closely for loss of consciousness, unequal or nonreactive pupils, and focal neurologic signs. Assess his vital signs. Is he increasingly difficult to arouse when you check on him at 20-minute intervals? Examine his arms, legs, and face (including tongue) for injury, residual paralysis, or limb weakness.
» READ BOOK EXCERPT ONLINE »
Source: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, 2007
Seizures, generalized tonic-clonic:
History
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
If you didn’t witness the seizure, obtain a description from the patient’s companion. Ask when the seizure started and how long it lasted. Did the patient report any unusual sensations before the seizure began? Did the seizure start in one area of the body and spread, or did it affect the entire body right away? Did the patient fall on a hard surface? Did his eyes or head turn? Did he turn blue? Did he lose bladder control? Did he have any other seizures before recovering? Does he complain of headache and muscle soreness? Is he increasingly difficult to arouse when you check on him at 20-minute intervals?
Next, obtain a history. Has the patient ever had generalized or focal seizures before? If so, do they occur frequently? Do other family members also have them? Is the patient receiving drug therapy? Is he compliant? Also, ask about sleep deprivation and emotional or physical stress at the time the seizure occurred.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Seizures, generalized tonic-clonic:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
If you didn't witness the patient's seizure, obtain a description from his companion. Ask when the seizure started and how long it lasted. Did the patient report unusual sensations before the seizure began? Did the seizure start in one area of the body and spread, or did it affect the entire body right away? Did the patient fall on a hard surface? Did his eyes or head turn? Did he turn blue? Did he lose bladder control? Did he have other seizures before recovering?
If the patient may have sustained a head injury, observe him closely for loss of consciousness, unequal or nonreactive pupils, and focal neurologic signs. Does he complain of headache and muscle soreness? Is he increasingly difficult to arouse when you check on him at 20-minute intervals? Examine his arms, legs, and face (including tongue) for injury, residual paralysis, or limb weakness.
Next, obtain a history. Has the patient ever had generalized or focal seizures before? If so, do they occur frequently? Do other family members also have them? Is the patient receiving drug therapy? Is he compliant? Also, ask about sleep deprivation and emotional or physical stress at the time the seizure occurred.
Next, assess the patient's level of consciousness (LOC) and proceed with a complete neurologic examination.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
LYMPHADENOPATHY, GENERALIZED:
Approach to the Diagnosis
(Differential Diagnosis in Primary Care)
Obviously, it is tempting simply to do a lymph node biopsy, but certain
other procedures should be done first. If the patient is febrile, febrile
agglutinins, monospot test, blood cultures, and cultures of any other
suspicious body fluid should be made. A fluorescent treponemal antibody
absorption test (FTA-ABS) test should be done as well as a chest x-ray and
tuberculin test to rule out tuberculosis. A blood count usually shows
leukemia, but a bone marrow biopsy may be necessary to diagnose leukemia, Hodgkin lymphoma, and
the reticuloendothelioses. Other x-rays, skin tests, and special diagnostic
procedures may be necessary.
» READ BOOK EXCERPT ONLINE »
Source: Differential Diagnosis in Primary Care, 2007
WEAKNESS AND FATIGUE, GENERALIZED:
Approach to the Diagnosis
(Differential Diagnosis in Primary Care)
The association of other symptoms and signs with generalized weakness
and fatigue is very important in pinning down a diagnosis. Generalized
lymphadenopathy and fatigue suggest infectious mononucleosis, lymphoma, or
tuberculosis or other chronic infection such as acquired immunodeficiency
syndrome (AIDS). Weakness, weight loss, and polyphagia with polyuria and
polydipsia would suggest hyperthyroidism or diabetes mellitus. Generalized
weakness with polyuria and no significant weight loss suggests
hyperparathyroidism. Weakness with pallor suggests some type of anemia.
Weakness and weight loss without polyuria or polyphagia suggest malignancy
or malabsorption syndrome. Weakness with other significant neurologic signs
and symptoms prompts the consideration of muscular dystrophy, amyotrophic
lateral sclerosis, or multiple sclerosis. Weakness with drug or alcohol use
prompts the investigation of drug or alcohol abuse. Caffeine, especially in
large quantities, can also cause significant weakness and chronic fatigue.
The initial workup of weakness and fatigue requires a CBC, sedimentation
rate, drug screen, chemistry panel, thyroid profile, ANA, chest x-ray, and
echocardiogram (ECG). If muscular dystrophy or dermatomyositis is suspected,
urine tests for creatinine, creatine, and myoglobin can be done. Ultimately,
a muscle biopsy may be indicated. If myasthenia gravis is suspected, serum
for acetylcholine receptor antibody may be done. If Addison disease is
suspected, a serum cortisol test may be done. A 24-hour urine aldosterone
level may be done to exclude primary aldosteronism. Serum parathyroid
hormone (PTH) may be done to exclude hyperparathyroidism.
It would be wise to consult an infectious disease specialist before ordering
an expensive workup. It would also be wise to consult an oncologist when
searching for a malignancy before ordering an expensive workup.
When all tests have negative findings, many clinicians have been tempted to
make a diagnosis of chronic fatigue syndrome. It is questionable whether
this is truly a disease or not.
» READ BOOK EXCERPT ONLINE »
Source: Differential Diagnosis in Primary Care, 2007
RASH, GENERAL:
Approach to the Diagnosis
(Differential Diagnosis in Primary Care)
Any condition with pus should be cultured. If a fungus is suspected, a
Wood’s lamp examination and a fresh potassium hydroxide (KOH) preparation
should be done. Skin biopsy is useful and is necessary in some cases. A
dermatologist should be consulted if there is any question about a
malignancy, if the condition persists, or if the symptoms are systemic. It
is foolish to persist in treatment without a definitive diagnosis for more
than 2 or 3 weeks when one may be dealing with something serious.
» READ BOOK EXCERPT ONLINE »
Source: Differential Diagnosis in Primary Care, 2007
A routine check-up may find that you have too many white blood cells, a sign of leukemia. What can be done? Learn about leukemia and how new...
The genetics of chronic myeloid leukemia are now well understood. Listen to researchers as they explain the path they took to their remarkable...
Chronic lymphocytic leukemia or CLL accounts for 25% of all leukemias in the U.S., most common in adults over 50. It affects certain white blood...
A wide range of laboratory tests is used to monitor a patient's response to therapy for chronic myeloid leukemia. Listen to experts explain the...
See full list of 24 related videos
» Next page: Signs of Leukemia
Rate This Website
What do you think about the features of this website?
Take our user survey and have your say:
Website User Survey
Medical Tools & Articles:
Next articles:
Tools & Services:
Medical Articles:
Forums & Message Boards
- Ask or answer a question at the Boards:
