Paediatric-History taking & Physical examination of a patient with Acute lymphoblastic leukemia (ALL)

Paediatric-History taking & Physical examination of a patient with Acute lymphoblastic leukemia (ALL)Created OnApril 28, 2020Last Updated OnApril 28, 2020byadmin You are here: Main Clinical Examination Paediatric-History taking & Physical examination of a patient with Acute lymphoblastic leukemia (ALL) < All Topics Table of Contents History Taking: Ask about identification – Age, sex (more common in children <6 years, male) Ask about history of presenting illness Symptoms of bone marrow infiltration by leukemic cells Can be sudden onset wit h rapid progression Usually present for weeks Anaemia – lethargy, fatigue, weakness, dyspnoea, dizziness Thrombocytopenia – abnormal bleeding tendencies, epistaxis, gum bleeding, petechiae, purpuric rash Neutropenia – prolonged fever, recurrent infections Symptoms of organ infiltration by leukemic cells Painless lymph node enlargement is common in ALL, also it can be the first presenting feature. Abdominal pain (due to infiltration of liver and spleen) Bone pain (patient may present with limping gait, unable to weight bear in a previously walking children) Headache, stiffed neck, visual field disturbance (meningeal leukemia) Painless testicular swelling (testes involvement) Night sweats, unexplained weight loss and loss of appetite Ask about past medical history Previously diagnosed malignancy Any treatment with chemotherapy Ask about social history Exposure to cigarette smoking Exposure to benzene and ionizing radiation Ask about family history Family history of ALL Ask about other histories as indicated – birth, immunization, nutrition and developmental history should be taken. Physical examination: General appearance, level of consciousness and vital signs recorded Look for any pallor, jaundice or respiratory distress Stridor, wheezing, superior vena cava syndrome are associated with mediastinal masses Look for any rash – colour, distribution and size of the purpura. Petechiae, purpura, ecchymoses due to thrombocytopenia Examination of the extremities Look for any painful bone or joint Examination of lymph node Painless lymphadenopathy is very common in ALL. Usually generalised, non-tender, firm, rubbery and matted. Anterior mediastinal masses – mediastinal adenopathy, thymic infiltration As a general rule, a lymph node is considered enlarged if it is >10 mm in its greatest diameter. Abdominal examination...

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