Anthropometric Measurements/ Lymph nodes Flashcards
Waist circumference and waist-hip-ratio what is normal
Abdominal obesity has different cuff-off points for males and females:
Waist Circumference (greater than)
Male 102 cm / 40 in
Female 88cm / 35 in
**WHR cuff-off values for males and females:
Waist-to-Hip Ratio
Male 1
Female 0.85
How to Perform: STEPS TO DETERMINE WAIST-TO-HIP RATIO
Measure waist circumference (W) at the midpoint between the lower costal margin and the iliac crest.
Measure hip circumference (H) at the widest part of the gluteal region.
Divide waist circumference by hip circumference to get your WHR value (W/H = WHR).
Interpret patient risk based on cuff-off values (above).
WHR and there associations
Clinical Relevance
Abdominal adiposity is an important independent risk factor for cardiovascular disease, type 2 diabetes, dyslipidemia, and hypertension. Even after adjusting for BMI, individuals with larger waist circumferences are strongly associated with mortality and have a more than 5X greater risk of multiple cardiometabolic risk factors, compared with individuals with waist measurements below the stated cut-off values. Waist circumference is also a criterion for metabolic syndrome (defined as the presence of three or more of the following five variables: large waist circumference, hypertension, elevated triglyceride levels, low high-density lipoprotein [HDL] cholesterol levels, and elevated fasting glucose levels).
Waist-to-Hip Ratio (WHR)
Abdominal obesity (aka. apple-shaped obesity) has a much worse prognosis than gluteal-femoral obesity (aka. pear-shaped obesity). Adverse health outcomes significantly increase once WHR exceeds 1 in men and 0.85 in women. Even after controlling for BMI, WHR is strongly associated with elevated blood pressure and cholesterol level, as well as incidence of diabetes mellitus, stroke, coronary events, and overall mortality.
How do you palpate the lymph nodes and what does it mean:
Use the pads of your fingers to gently feel for lymph nodes.
Assess for:
Size
Tenderness
Consistency (soft, rubbery, hard)
Mobility (fixed vs. movable)
- Size:
Normal: Generally less than 1 cm in diameter.
Enlarged (Lymphadenopathy):
Small enlargement (<2 cm): Often reactive to infection (e.g., viral or bacterial).
Large enlargement (>2 cm): May indicate more significant infection, malignancy, or other systemic conditions. - Tenderness:
Tender Lymph Nodes:
Usually indicate inflammation or infection.
Common in bacterial infections (e.g., streptococcal pharyngitis) or acute viral infections (e.g., mononucleosis).
Non-tender Lymph Nodes:
May indicate malignancy (e.g., lymphoma, metastatic cancer) or chronic infection (e.g., tuberculosis).
- Consistency (Soft, Rubbery, Hard):
Soft:
Normal or mildly reactive lymph nodes.
Often seen in benign conditions like viral infections.
Rubbery:
Suggestive of conditions like lymphoma.
Hard:
Associated with malignancy, especially when fixed to surrounding tissues.
Hard, irregular nodes may also indicate metastatic cancer. - Mobility (Fixed vs. Movable):
Movable:
Normal or reactive lymph nodes.
Typically seen in infections or benign processes.
Fixed:
May suggest malignancy, chronic inflammation, or scarring from a previous infection.
Fixed nodes are often adhered to underlying tissues, which is concerning for cancer or invasive infection.
Neck Circumference
16 inches or more indicates The STOP-Bang (snoring, tiredness, observed apnea, blood pressure, body mass index, age, neck size, gender) questionnaire has established the cut-off at ≤ 40cm (15.7 inches), which increases the risk of Obstructive Sleep Apnea (OSA).
How much weight gain and what is the timeframe that warrants
Congestive Heart Failure (CHF):
Weight Gain in CHF:
CHF-related weight gain is typically rapid and caused by fluid retention, not an increase in fat or muscle.
Patients can gain several pounds in a few days or weeks, often accompanied by swelling (edema) in the legs, abdomen, or lungs.
Other Symptoms Suggestive of CHF:
Shortness of breath (dyspnea), especially when lying down.
Persistent cough or wheezing.
Fatigue or weakness.
Swelling in the ankles, feet, legs, or abdomen (ascites).
Rapid heart rate or palpitations.
Key Indicator:
A weight gain of more than 2–3 pounds (1–1.5 kg) in 24 hours or 5 pounds (2.3 kg) in a week is considered concerning for CHF and warrants immediate evaluation.
Unintended weight loss can be a significant red flag for cancer or other serious illnesses. The speed and amount of weight loss, along with associated symptoms, determine its clinical significance. Here’s how weight loss is evaluated for its potential link to cancer:
Magnitude of Weight Loss:
Unexplained weight loss of >5% of body weight in 6–12 months is concerning.
For example, a 70 kg (154 lbs) individual losing 3.5 kg (7.7 lbs) unintentionally in 6–12 months.
Rapid or significant weight loss over a shorter time (e.g., weeks to months) is even more concerning.
Duration of Weight Loss:
Weight loss over weeks to months is more worrisome if associated with systemic symptoms.
Weight loss occurring gradually over years may suggest less aggressive conditions like chronic disease or malnutrition.
Rate of Weight Loss:
Faster weight loss (>1–2 lbs per week) without dietary or lifestyle changes is more likely to indicate a serious underlying condition.
Red Flags for Cancer-Related Weight Loss:
Weight loss becomes more suspicious for cancer when associated with systemic symptoms or findings, such as:
General Symptoms:
Fatigue.
Fever or night sweats.
Persistent pain (e.g., abdominal, bone, or chest pain).
Gastrointestinal Symptoms:
Loss of appetite (anorexia).
Persistent nausea or vomiting.
Difficulty swallowing (dysphagia).
Persistent diarrhea, constipation, or changes in stool appearance.
Blood in stool or black/tarry stools.
Other Specific Symptoms:
New or worsening lumps or masses.
Persistent cough or hoarseness (lung or throat cancer).
Jaundice or changes in skin color (liver or pancreatic cancer).
Unexplained bleeding or discharge.
Cancer Types Commonly Associated with Weight Loss:
Gastrointestinal cancers (e.g., stomach, pancreatic, esophageal, colorectal).
Lung cancer (due to systemic effects like cachexia or tumor burden).
Hematological cancers (e.g., lymphoma, leukemia).
Head and neck cancers (e.g., difficulty swallowing leads to reduced intake).
Advanced cancers with systemic effects like cachexia.
Mechanisms of Weight Loss in Cancer:
Cancer Cachexia:
A metabolic syndrome causing significant weight loss, muscle wasting, and fat depletion despite adequate caloric intake.
Common in advanced cancer stages.
Obstruction or Local Effects:
Tumors in the gastrointestinal tract may interfere with swallowing or digestion.
Systemic Inflammation:
Cancer can produce inflammatory cytokines, increasing resting energy expenditure and reducing appetite.
Investigations to Identify Cancer:
If weight loss is concerning, the following steps are typically taken:
History and Physical Exam:
Thorough review of associated symptoms.
Physical exam for masses, lymphadenopathy, or organomegaly.
Basic Laboratory Tests:
CBC: Look for anemia or abnormal white blood cell counts.
CMP: Check liver and kidney function.
ESR/CRP: Indicate systemic inflammation.
Imaging:
Chest X-ray, CT, or MRI to look for tumors.
Ultrasound for suspected abdominal or pelvic malignancies.
Cancer Markers (if indicated):
PSA (prostate), CA-125 (ovarian), CEA (colorectal), etc.
Endoscopic Procedures:
Colonoscopy or endoscopy for gastrointestinal cancers.
Biopsy:
Confirmatory test for any suspicious mass or lesion.
When to Suspect Cancer Based on Weight Loss Alone?
Unexplained weight loss of >5% body weight in 6–12 months.
Associated symptoms, such as fatigue, night sweats, or localized pain.
Risk factors, such as smoking, family history, or occupational exposures.
Would you like guidance on specific types of cancers or further management details
What is a quick measure if you are only given pounds and feet for BMI
Body Mass Index
* Body mass index (BMI) = weight (KG)/ height (M) squared.
* BMI 18.5-24.9 = “healthy” weight range.
* BMI 25.0-29.9 = overweight.
* BMI > 30.0 = obese.
* Overweight is defined as a BMI at or above the 85th percentile and below the 95th percentile for children and teens.
- Obesity is defined as a BMI at or above the 95th percentile for children and teens
To calculate BMI (Body Mass Index) quickly in your head when given feet and pounds, you can use a simplified formula:
Formula for BMI:
BMI=weight(inpounds)
height(ininches)2×703
BMI= height(ininches) 2weight(inpounds) ×703
Steps to calculate BMI quickly:
Convert height to inches:
If the height is in feet and inches, convert it to inches.
1 foot = 12 inches.
For example, for someone 5 feet 8 inches tall:
5ft×12+8inches=60+8=68inches
5ft×12+8inches=60+8=68inches
Square the height in inches:
Take the height in inches and multiply it by itself (square it).
For example, for 68 inches:
682=4624
Use the formula:
Divide the weight by the squared height in inches and multiply by 703.
For example, if the person weighs 150 pounds:
BMI=150/4624×703=22.8
Quick Estimation (for mental math):
To make it faster in your head, you can round the height to the nearest 5 or 10 inches for an approximate result.
Use the BMI categories for rough assessments:
Underweight: BMI < 18.5
Normal weight: BMI 18.5–24.9
Overweight: BMI 25–29.9
Obese: BMI ≥ 30
What is the BMR formula and what factors effect them?
Basal Metabolic Rate
+Thermal Effect of Food
+ Non- Exercise Activity Thermogenesis
+Exercise
= Calories out
Post Meal Thermogenesis (PMT)
* Also termed the thermic effect of food. This denotes the fact that every time food is consumed, there is an increase in basal energy expenditure, as a result of processes of digestion. This value ranges from 5-15% of BMR.
NON- EXERCISE ACTIVITY THERMOGENESIS (NEAT)
- This denotes all daily activities. For example, brushing teeth, washing dishes, reading, standing ETC, other than exercise
Appetite Hormones
* Leptin suppresses appetite as its level increases – produced by fat tissue
* PYY – suppresses appetite – secreted by SI after meals – counters ghrelin
* Ghrelin – signals hunger and increased in people who follow traditional diet
