Jorge E. Romaguera, MD

M.D. Anderson Cancer Center, University of Texas, Houston, TX

Copyright of the American Society of Hematology, 2006. ISSN: 1931-6860.

This case was reviewed and updated in January 2011 by Dr. Peter Marks and members of the Teaching Cases Subcommittee.


What should you look for on his physical exam that would help you to narrow the differential diagnosis? Consider each of the following and click on the items you believe will best help you make a diagnosis.

Carotid bruits
A "drawer sign"
Joint abnormalities
Assessment of liver and spleen size
A source of infection on the patient’s right leg or in his genital or rectal area
Intact tympanic membranes
Other sites of adenopathy
The location, size, and quality of the point of maximal impulse (PMI)
Skin lesions


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