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Lymphoreticular Exam

Introduction

Greetings
Hand wash
Verify the patient's identity
Explanation of the examination
Obtain consent
Position patient at 45° on bed
Adequately expose patient

General Inspection

Look for signs of cachexia
Check for swelling (hepatosplenomegaly)
Assess for pallor
Note any skin changes
Look for bruising

Hands

Check for koilonychia
Look for signs of Raynaud's phenomenon
Check for digital infarction
Look for purpura and petechiae
Assess palmar crease for pallor
Palpate epitrochlear lymph nodes

Flex elbow to 90°, palpate above medial epicondyle

Examine axillary lymph nodes

Palpate all groups: pectoral, central, subscapular, lateral, apical

Head Examination

Examine eyes

Check for jaundice, hemorrhages, redness, conjunctival pallor

Examine mouth

Look for gum hypertrophy, ulcers, hemorrhages, atrophic glossitis

Palpate cervical lymph nodes

Include submental, submandibular, tonsillar, parotid, pre/post-auricular, occipital, superficial/deep cervical, supraclavicular

Abdominal Examination

Inspect for petechiae, purpura, bruising, ulcers, distention
Palpate abdomen
Palpate for liver enlargement
Palpate for spleen enlargement
Palpate inguinal lymph nodes

Palpate horizontal and vertical groups

Conclusion

Summarize findings
Suggest further tests if needed

Consider FBC, ultrasound if indicated

Exam Progress

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