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1、Toooften,thephysicianrushesintothephysicalexaminationwithoutlookingatthepatientforanunusualhabitusorappearanceofunderdevelopment,malnutrition,orchronicillness.Thesefindingscanbeimportantcluestotheunderlyingetiologyofdiseaseandprovideinformationrelatedtothedurationofillnes
2、s.Theskinandmucousmembranesareoftenbypassedsothatpallor,abnormalpigmentation,icterus,spidernevi,petechiae,purpura,angiomas,ulcerations,palmarerythema,coarsenessofhair,puffinessoftheface,thinningofthelateralaspectsoftheeyebrows,naildefects,andausuallyprominentvenouspattern
3、ontheabdominalwallaremissedintherushtoexaminetheheartandthelungs.1．Performsystematicexaminationforpalpableenlargementoflymphnodesforevidenceofinfectionorneoplasia.Bilateraledemaisusefulindisclosingunderlyingcardiac,renal,orhepaticdisease,whereasunilateraledemamayportendly
4、mphaticobstructionduetoamalignancythatcannotbeobservedorpalpated.2．Carefullysearchforbothhepatomegalyandsplenomegaly.Theirpresenceorabsenceisimportant,asarethesize,thetenderness,thefirmness,andthepresenceortheabsenceofnodules.Inpatientswithchronicdisorders,theseorgansaref
5、irm,nontender,andnonnodular.Inpatientswithcarcinoma,theymaybehardandnodular.Thepatientwithanacuteinfectionusuallyhasapalpablysofterandmoretenderorgan.History:1.Patientswiththromboticthrombocytopenicpurpura(TTP)typicallyreportanacuteorsubacuteonsetofsymptomsrelatedtoneurol
6、ogicdysfunction,anemia,orthrombocytopenia.1)Neurologicmanifestationsincludealterationinmentalstatus,seizures,hemiplegia,paresthesias,visualdisturbance,andaphasia.2)Fatiguemayaccompanytheanemia.3)Severebleedingfromthrombocytopeniaisunusual,althoughpetechiaearecommon.2.Feve
7、roccursinapproximately50%ofpatients.3.Patientsalsomaynoticedarkurinefromhemoglobinuria.4.ClinicaldifferentiationofHUSandTTPcanbeproblematicanddifferentiationisoftenbasedonthepresenceofCNSinvolvementinTTPandthemoresevererenalinvolvementinHUS.InHUS,anantecedenthistoryofdiar
8、rhealillnessismoreoftenpresent.Infact,someinvestigatorsaresuggestingaclinicalclassificationofHUS
