Clinical Assessment Flashcards
What sign is observed in the eyes that signifies anemia?
Pale palpebral conjunctiva
Bilateral “peeling paint” os skin areas not exposed to sunlight
Flaky paint dermatitis
Possible conditions associated with edema
- Albumin problems (liver)
- kidney damage: conentrating and diluting abilities are affected
Very deep taking longer than 20 sec to rebound
4+ edema
Signs frequently observed during inspection
- state of nutrition
- body habitus or sshape
- body size
- presence of asymmetry
- posture and gait
- speech
Cuticle peel off/Maceration of cuticle
flaky nail
Conducted by a medical doctor and uses an instrument to further assess a patient by listening to sounds produced by internal organs
auscultation
Slight pitting without distortion, rapidly disappears
+1 edema/mild edema
Deeper pit that takes a few seconds to rebound
+2 edema/moderate
What signs are observed when assessing gums
- Spongy, bloody gums
- Pale gum color
What signs are observed when assessing the teeth?
- tooth decay
- missing teeth
4 Characteristics of Pellagra
- Dermatitis
- Diarrhea
- Dementia
- Death
Visual examination of the patient for signs that are highly observable through the patient’s appearance
inspection
Horizontal grooves/Line in nails
Beau’s/transverse line
Conditions that cause clubbing of nails
- chronic hypoxia
- cancer: increased oxygen demand for cancer cells
Possible Nutrient Causes of Mouth lesions
Vit B12, Vit A, Vit C deficiency
Comes from the word sebum
Nasolabial seborrhea
What is assessed when palpating along the mid axilliary line
- Prominence of the ribs and iliac crest
Related health concerns in the mouth and their causes
- teeth problems: fluorine
- gums: collagen
- Pale insides of mouth: anemia
Possible nutrient cause of pallor
Iron deficiency (cause IDA)
Pale skin color
Pallor
What conditions of the skin are observed or checked for during physical examination?
- Petechiae
- Dermatitis
- Pellagrous Dermatitis
- Flaky Paint Dermatitis
- Xerosis
- Pallor
- Non-healing wounds
- Nasolabial seborrhea
What muscle is assessed in the hands?
Interosseus Muscle
Possible nutrient cause of xerosis
Vitamin A deficiency
What signs are checked or looked for when assessing the back?
Prominence of scapula, spine, and ribs
How does diabetes cause non-healing wounds
- High blood glucose can damage nerve fibers, decreasing sensation which prevents immediate wound treatment
- Bacteria can use the excess blood glucose causing infection
Possible Nutrient Causes of Koilonychia
Iron, b12, Vit C deficiency
What is observed or check for when assessing the parotid gland
- enlargement
- tenderness/pain
what causes purple nail bed
Decreased oxygen delivery
Possible Nutrient Causes of Petechiae
Vitamin C deficiency, Vitamin K deficiency
Possible Nutrient Causes of Enlargement/Pain of the thyroid gland
Iodine deficiency
Somewhat deeper pit, distortion not easily apparent, disappears 10-25 sec later
+2 edema/moderate
Hyperpigmentation of sunlight/trauma exposed areas
Pellagrous dermatitis
4-6 mm (depth of pit)
+3 edema/severe
What other non-nutrient causes of alopecia
Too much heat can dry hair and damage hair follicles
Conditions observed or checked on hair during physical examination
- Alopecia
- Lightened hair color
- Corkscrew Hair
How to check for tricep skinfold
- Ask patient to bend arm at 90 degree angle with upper arm perpendicular to the body
- If patient is unable to cooperate, bend the elbow at 90 degress and place forearm horizontally across the body
- Grasp the upper arm MIDWAY between shoulder and elbow
- Pull skin away from arm while wiggling slightly to separate fat from muscle
What sign should be observed when checking the chest muscles
- fullness
- firmness
- prominence of the clavicle
4 basic physical examinatiton techniques
- inspection
- palpation
- percussion
- auscultation
What causes spongy bloody gums
vitamin c deficiency due to lack of collagen
How to check for clubing of nails
When thumbs no longer have a space iin between when placed together
What do you call the corners of the eyes
Lateral Canthus
Barely ddetectable depression, immediate rebound
+1 edema/mild
6-8 mm (depth of pit)
4+ edema
How to check for pale palpebral conjunctiva?
Pull down lower eyelid–> if all white, it means a sign of anemia
What is checked when assessing the calves
gastrocnemius should be large
What muscle is palpated when assessing the chest
Pectoralis major
2-4 mm (depth of pit)
+2 edema/moderate
What muscles are palpated when assessing the back (2)
- Trapezius
- Latissius dorsi
T or F: Fat deposit in the tricep is normal
True
2 mm or less (depth of pit)
+1 edema/mild
Possible nutrient cause of corkscrew hair
Vitamin C deficiency
Very deep pittinh, extremity is grossly misshapen, indentation lasts 2-5 min
4+ edema
Possible Nutrient Causes of Glossitis
Iron deficiency, Vitamin B2 deficiency, Vitamin B12 deficiency
Possible Nutrient Causes of Dermatitis
Vitamin B2 deficiency
What are being observed for on temples during physical examination
- depression
- hollowing
Possible Nutrient Causes of cheilosis
B2, zinc, B6 deficiencies
How is phenylalanine related to tyrosine deficiency?
Phenylalanine is converted to tyrosine
small hemorrhagic spots
Petechiae
Nutrient cause of Pellagrous Dermatitis (Pellagra)
Niacin Deficiency
What tools are used to assess the mouth of a patient during physical examination
- Pen light
- Tongue Depressor
How long should you apply moderate pressure when assessing swelling of foot/lower extremities
5 seconds
What signs are checked or looked for when observing both eyes?
- Cracked or reddened corners
- Dull, Dry or rough sclera
What areas/organ are typically assessed through auscultation
- heart, chest, and abdomen
What causes pale gum color
Iron deficiency (anemia)
What medical condition is associated with corkscrew hair
Scurvy
What is observed or hecked for when assessing the thighs
- roundness/fullness of muscles
- prominence of patella
Two main factors observed when assessing edema in foot/lower extremities
- depth of depression
- refill time (in seconds)
Scaling around nostrils
Nasolabial serborrhea
What conditions are observed for when assessing the nails (7)
- Koilonychia
- Beau’s/Transverse line
- Poor Blanching fo Nails
- Splinter hemorrhages
- Poor nail plate health
- Flaky nails
- Clubbing
Possible Nutrient Causes of Bitot’s Spot
Vitamin A deficiency
Pale nail bed
Poor blanching of nails
What signs are checked or looked for when assessing the shoulders
- fullness
- firmness
- squaring of shoulders
What does “bilateral” mean in flaky paint dermatitis
dermatitis is observed in left and right areas of the body (ex. if on left shoulder, it is also on the right shoulder)
Noticeably deep pitting, entire extremity looks full, swollen; indentation can last longer than 1 min
+3 edema/severe
What signs are observed or checked for on tongue
- Magenta/beefy red color
- Smooth, slick appearance
Unequal coloration of the nail bed
Poor nail plate health
What muscle is palpated when assessing the shoulders
Deltoid muscles
What are observe or checked for when assessing eyes?
- Darkness
- Hollowness
- Loose skin
Gray spongy spot/foamy areas on the white of the eye
Bitot’s spot
Why does Vitamin A deficiency cause xerosis
Vitamin A is a regulator of the epithelium of the skin
Biggest salivary gland
Parotid gland
Where is parotid gland located
Below the ear
Oily skin around the nasal area
Nasolabial serborrhea
What muscle is assessed when checking the temples
Temporalis muscles
What signs are observed when assessing the lips
- cheilosis
- angular stomatitis
PPossible Nutrient Causes of Keratomalacia
Severe Vit A deficiency
What causes decreased melanin production?
Tyrosine/Phenylalanine deficiency
What color should be the sclera of the eyes?
White
Possible Nutrient Causes of Flaky Paint Dermatitis
PEM, Free fatty acid deficiency, Zinc deficiency
Possible nutrient causes of poor blanching of nails
Iron deficiency
A condition indicative of uncontrolled Diabetes Mellitus
Non-Healing Wounds
Hazy, dull, milky, opaque cornea (destruction of cornea)
Keratomalacia
Possible Nutrient Causes of Angular Stomatitis
Vit B2, Iron, B12 deficiency
Pit even more pronounced, taking about 10-12 sec to rebound
+3 edema/severe
Use of sense of touch to feel for any abnormalities on an organ or body part
Palpation
Tongue inflammation, magenta in color
Glossitis
Nail plate eceeding 180 degrees
Clubbing
Possible Nutrient Causes of Alopecia
Vit B2 deficiency, Folate deficiency, Vit B12 deficiency
What is caused by injury to the nail
splinter hemorrhage
How to check for clubbing of nails
When thumbs no longer have a space iin between when placed together
What should be observed or checked for on the mucosa?
- Pallor
- Dryness
- Decreased Salivary flow
- Ulceration (Mucositis)
Hair thining or hair loss
Alopecia
Why does Vitamin A deficiency cause Bitot’s spot
Vit A is responsible for the epithelialization of the eye
What condition is characterizd be enlarged thyroid
goiter
Dry scaly, flaky skin
xerosis
technique done by hitting or tapping an area to produce a sound
percussion
What is observe or checked for when assessing the thyroid gland
- enlargement
- tenderness/pain
Swollen, reddened skin with or without blistering
Dermatitis
areas in the lower extremities where the skin overlies a bone
- shin
- malleolus
- dorsum of the foot
Sign of depigmentation (melanin)
Lightened hair color
Spoon-shaped nails/Concaved nail
Koilonychia
Possible nutrient cause of nasolabial seborrhea
Vitamin B6 deficiency, zinc deficiency
What causes alopecia in males and why?
Caused by high testosterone as they age due to the increased celluular division of hair follicles, which reduces the life span of hair follicles causing hair thinning or hair loss
How to check/assess the hands?
Ask patient to make the “OK” sign with thumb and forefinger
What area around the eyes do you palpate for assessment?
Orbital Pads
What signs is checked or looked for whn assessing the lower legs/feet
- asymmetry
- swelling
No impression or distortion observed, bone structure easily identified
No edema
What signs are checked or looked for when assessing the back?
Prominence of scapula, spine, and ribs
Medical condition for decreased melanin production
Albinism
Bilateral cracks and redness of the lips
Angular stomatitis
What signs are observed in mucositis or mouth/tongue ulcers
Mouth lesions
What signs are typically assessed during palpation
- muscle and fat mass
- tenderness
- presence of edema
- abnormal masses
Degree or severity of muscle atrophy on temples due to age
Only mild
