ID Miscellany|physical Exam|Signs|Humanities #idmesh
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Palpating for the epitrochlear nodes is an exam that I like to teach at bedside. When palpable, these nodes often indicate a condition characterized by generalized lymphadenopathy.
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Epitrochlear nodes (EN) are superficial nodes located 2-3 cm above and anterior to the medial condyle of the humerus.
Exam: shake patient's hand, on the side to be examined; examiner's free hand palpates for ENs π
Pics from:
aafp.org/afp/2016/1201/β¦
memorangapp.com/flashcards/802β¦
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ENs drain the ulnar forearm & the little/ring fingers.
Enlarged ENs are rare in healthy individuals (no more than few millimeters in size).
Unilateral enlargement can indicate localized cutaneous infection/malignancy/inflammation of the forearm/hands.
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ππ²π¦π¦πππ«π’π ππ§π₯ππ«π ππ¦ππ§π indicates a condition characterized by generalized LAD.
Historically, a/w secondary syphilis (at least 1/2 of cases).
jamanetwork.com/journals/jamadβ¦
sciencedirect.com/science/articlβ¦
Osler's two-handed hand-elbow salutation:
bmj.com/rapid-responseβ¦
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They can also be seen in:
βͺοΈ Mononucleosis & HIV (>50%)
βͺοΈ Lymphoma, CLL, sarcoidosis (30%)
βͺοΈ Rheumatoid arthritis (20%)
ncbi.nlm.nih.gov/pubmed/1588523
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A more recent review, however, shows us a wider range of disease associations π.
This review also identified:
βͺοΈ leprosy as most commonly associated pre-HIV
βͺοΈ HIV +/- TB, HIV pre-HAART era
βͺοΈ cat-scratch disease, most common infection post-HAART
ncbi.nlm.nih.gov/pmc/articles/Pβ¦
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Do you routinely palpate for epitrochlear nodes in your practice? Have you had opportunities that demonstrated its utility? Please feel free to leave your comments.
@AndreMansoor @DxRxEdu @TxID_Edu @BradCutrellMD @DocWoc71 @Darcy_ID_doc @MohitHarshMD
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