醫學筆記匯整 ED Notes

- Infection : Sa, Strept, Cat scratch, EBV, CMV, TB
- Rheuma : SLE, RA
- Malignancy


 

Hx :

• 多久 ? 
  - 幾個月幾年沒什麼變化都算 stable
  - Leukemia, lymphoma 長得快通常 1-3W 就有明顯變化
  - 才長幾天內, 再觀察就好
• Fever, infection ( esp ENT ), systemic infection
• Weight loss, weakness
• Chronic disease, immunodeficency
• 養寵物 ? 
• 最近有注射疫苗 ? BCG 
   
• Acute infection 之 LNs 通常 2W - 1M 都要消掉
• 通常 > 1 cm 會比較需要擔心

PE :

• 只能 Light touch, 不能太用心 compression
  Malignancy 怕會 spreading 
   
• Movable / fixed
• Hard / soft/ rubber
• Size > 1 cm ?
• Painful / Painless
• Tenderness ?
• Location, single / multiple 
   
• Supraclavicular ( Virchow node ) :
  若有則要懷疑 mediastinum, Lung, GI 之 ca
• Axillae
• Hepatosplenomegaly
• Anemia
• Petechia, ecchymosis 
• Inguinal ligment area
   

  
   

  
  
  
   

右鎖骨上 Right supraclavicular adenopathy
is associated with cancer in the mediastinum, lungs, or esophagus.

左鎖骨上 Left supraclavicular adenopathy, Virchow's node
suggests abdominal malignancy
(eg, stomach, gallbladder, pancreas, kidneys, testicles, ovaries, lymphoma, or prostate)

頭頸癌轉移很少會到supraclavicular lymph node
所以當看到supravlavicular lymph node時比起頭頸癌
更應該考慮頭頸部以下的癌症

http://www.aafp.org/afp/1998/1015/p1313.html#
 

Lab : CBC/ DC, smear, B/C, LDH, ALT 

• Staphy, Strept, Cat scratch
• Lymphoblast
• Atypical lymphocyte : CMV, EBV
• 即使 WBC morphology 沒有 blast, 也不能完全排除 ALL
  可能早期 blast 還沒滿出來到周邊, 
  有需要還是可以做 marrow aspiration
• LDH : Cell lysis ( Hemolysis, tumor lysis )
• ALT : EBV, CMV 會 liver function
   
• CMV : IgM, IgG
• EBV : Early antigen, VCA ...