Palpation Guided Fine Needle Aspiration
Patient History and Exam
Author: Joe D. Jakowski, M.D. (see Reviewers page)
Revised: 19 August 2013, last major update August 2013
Copyright: (c) 2013, PathologyOutlines.com, Inc.
Focused Patient History and Physical Exam for the FNA Patient
Evaluating the Patient History of Symptoms:
Physical Examination of the Patient’s Lump:
- Taking a patient history of symptoms is facilitated with mnemonic "OPQRST":
- Who first noticed the condition?
- What was the patient doing / what was going on when the symptoms became apparent (e.g. trauma to the area, concurrent infections?)
- Was the onset sudden, gradual, or appears to be chronic
- Provocation or Palliation
- Whether any movement, palpation, medications, or other external factor makes symptoms better or worse
- This is the patient's description of associated symptoms, for example pain, with additional qualifiers of sharp, dull, crushing, burning, tearing; also the pattern of pain, such as intermittent, constant, throbbing
- Region and Radiation
- Example: "Is this the only enlarged lymph node have noticed or are there more in a different area?"
- If there is pain in a lump, you can ask if it extends or moves to any other area
- If there is pain you can assess with a pain score (usually on a scale of 0 to 10) or ask as a comparative such as "... compared to the worst pain you have ever experienced"
- Time (history)
- Example: "How long has the lump been there and how it has changed since onset?"
- "Has this swelling ever happened before?"
- Below are key characteristics to assess during physical examination of a patient’s lump and also for documentation purposes if needed for billing of Evaluation and Management (E/M) CPT codes:
- Site, Size, Shape, Surface, Skin, Scar
- Tenderness, Temperature, Transillumination
- Regional lymph nodes
Physical Exam Signs and Findings to Assess the Differential Diagnoses of in the FNA Patient
Common Painful Skin Tumors: Can be remembered by using the pneumonic "LEND AN EGG": (J Am Acad Dermatol 1993;28:298)
- A helpful mnemonic to remember the broad categories of differential diagnoses in a patient is given by the mnemonic "MINT CANDY":
- Collagen vascular disease
- 'N'ything else
- Youth–congenital disease
Sister Mary Joseph sign or node: palpable nodule of the umbilicus as a result of metastasis of a pelvic or abdominal cancer (most commonly gastric, colonic or pancreatic cancer or gynecologic tract cancer in women)
- Eccrine spiradenoma
- Glomus tumor
- Granular cell tumor
Virchow's node: lymph node in the left supraclavicular fossa that is enlarged, firm, and strongly indicative of metastatic cancer from the abdomen (especially gastric cancer); differential also includes lymphoma, other intra abdominal malignancies, breast cancer, and infection (e.g. of the left arm)
Dimple sign or Fitzpatrick's sign: dimpling of the skin with lateral compression, considered by many to be pathognomonic for dermatofibroma
Positive Tinel's sign: paresthesias / pain / tingling elicited by mechanical stimulation over the distribution of the nerve suggest peripheral nerve tumors (schwannona, neurofibroma)
- Simple technique for examination of superficial lumps which involves a bright light that is projected at or through an area of interest, for example, in the head and neck or breast
- To perform, the exam room lights are dimmed or turned off and a bright light is then pointed at a location on the body to be examined
- Solid masses will tend to be black, cysts will tend to light up or illuminate
End of Cytopathology > Palpation Guided Fine Needle Aspiration > Patient History and Exam
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