DR SIMON ATTARD MONTALTO
Where?
How long for?
Changes in size, colour, texture?
Painful?
Warm?
Any preceeding problem?
Related symptoms:
Discharge?
Thyroid function?
Respiratory symptoms?
Gastrointestinal symptoms?
Genitourinary symptoms?
Malaise, lethargy?
Weight loss/gain?
Temperature?
Sweats?
Symptoms of anaemia?
Aches, bony pain?
Similar problem in past?
Previous illnesses.
Head/neck:
? lymphadenopathy,
? skin, subcutaneous tissue
? soft tissues
? bony
? thyroid
? other masses, evidence of disease
Thorax:
? lymphadenopathy,
? skin, subcutaneous tissue
? soft tissues
? bony
? other masses, evidence of disease
Abdomen:
? tender
? site
? size, consistency, surface, edge
? dull to percussion
? move with respiration
? warm, bruit
? margins (get above/below)
? other masses, evidence of disease
Limbs:
? lymphadenopathy,
? skin, subcutaneous tissue
? soft tissues
? bony
? other masses, evidence of disease
Tailored to the differential diagnosis following the clues provided by the history and examination. Not a blanket exercise sceening for every possibility!
Single/muliple enlarged LM – CBC and infection screen if infection is likely; imaging and bone marrow if neoplasia is suspected.
A What is it? (histology)
biopsy (needle, trucut, CT guided, open)
B How much? (staging)
Organ dysfunction CBC, LFT, TFT
Bone Marrow BM aspirate
Imaging CXR, x-rays, US, CT, MRI
Isotopes bone scan, thyroid
Specia MIBG