Clinical Assessment Flashcards by Joram Manio

______ are physical manifestations that a clinician/observer observe

Signs

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Two types of deficiency

Macronutrient
Micronutrient

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_____ are subjective experiences by the patient

Symptoms

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Symptoms can only be noted by proper ______

History taking

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Symptoms can be noted by:

Subjective complaints
Medical history
Anthropometric changes
Physiological abnormalities

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NFPE allows screening of __________

Micronutrient deficiencies

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What are the steps of NFPE?

General Inspection
Head and Neck
Chest and back
Abdomen
Skin and extremities

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Basic techniques of NFPE

Inspection
Auscultation
Palpation
Percussion

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Hair problems can be suspected to be connect to _________

Protein and biotin deficiency

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Dull, Dry or Brittle Hair is associated with ____

Deficiencies in protein, essential fatty acids, Vitamin B7 (Biotin), and copper.

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It is speculated that the hairs actively cycling during the_____ are the ones that experience hair shaft and hemorrhagic complications.

lowest ascorbic acid levels

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Easily pluckable hair can suggest deficiencies in ______

Protein and zinc

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Corkscrew or Coiled Hair

Deficiency in Vitamin C

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Thin or sparse hair

Deficiencies in protein, essential fatty acids, zinc, and Vitamin B7 (Biotin)

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Scaly scalp

Usually associated with zinc deficiency, but may also be a sign of B6 Deficiency

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For temporal area inspection of face, inspect and palpate the _____ from the front

Temporalis muscle

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Palpate the _____ and ____ during orbital area inspection

Eye sockets and fat pads above cheek

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Normal Eyes description

Bright with smooth cornea and pink and moist membranes

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One should noted the following changes during patient interview

night vision, dryness, and/or inability to
produce tears

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Most common consequence of Vitamin A deficiency

Nyctalopia (night blindness)

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Xeropthalmia’s most readily recognized as ______

excessive dry eyes

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Bitot’s Spots description

Presence of triangular, whitish, foamy lesions in the sclerae due to abnormal keratinization, and superficial patches on the bulbar conjunctiva

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Palpebral conjunctivae should be _____ in color

Pink

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White or Pale color is an indication of ______

deficiencies in Iron (Microcytic anemia), Vitamin B9 (Folate), and Vitamin B12 (Cobalamin)

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Inflammation is usually more caused by infection, but it can also suggest _____

Vitamin B2 (Riboflavin) and Vitamin B3 (Niacin)

Xerosis signs

drying of the conjunctiva or cornea

Keratomalacia signs

cloudiness and softening of the cornea, and may lead to ulcerations

Description of Normal extraoral cavity

Without cracks and sores, and appears smooth and pink in color

Description of Normal intraoral cavity

Appears free of swelling around the gum and tongue

Vitamins which Aid in cellular synthesis, function, and integrity of your mucosa (oral cavity)

B-complex Vitamins and Vitamin C

Most common deficiency of mouth and oral cavity

Vitamin B2 (Riboflavin)

Xerostomia (Dry Oral Mucosa)

Indication of possible dehydration

Angular stomatitis or cheilosis can suggest _____

Abnormalities in Vitamin B2 (Riboflavin), Vitamin B3 (Niacin), and Vitamin B6 (Pyridoxine)

Glossitis Signs

Beefy red tongue with atrophied papillae

Glossitis can signify _____-

Deficiencies in Protein, B1 (Thiamin), Vitamin B2 (Riboflavin), Vitamin B9 (Folate), Vitamin B12 (Cobalamin), and iron.

TRUE OR FALSE: Iron would manifest more as pallor

TRUE

Magenta colored tongue

Deficiencies in Vitamin B2 (Riboflavin), Vitamin B3 (Niacin), Vitamin B9 (Folate), Vitamin B12 (Cobalamin), and iron

Oral cavity pallor can be due to

- Anemia - Deficiencies in Vitamin B9 (Folate), Vitamin B12 (Cobalamin), and iron

Inflamed Oral Cavity Mucosa

Possible deficiencies in Vitamin B-complex like B1 (Thiamin) and Vitamin B2 (Riboflavin)

Bleeding Gums and Poor Dentition (Scurvy)

Deficiency in Vitamin C (Ascorbic Acid) causes scurvy

Dysgeusia or Hypogeusia is caused by ___

Deficiency in zinc and toxicity

Dysgeusia

Difficulty/Lack of sense taste; distorted taste

Hypogeusia

Decreased in sensitivity of taste; diminished taste

The neck is not necessarily part of the micronutrient deficiencies assessment except for _____

the thyroid gland

The neck is usually used to assess ____

Muscle wasting

The neck can provide information on ____

Muscle and fluid status

Distended Neck Veins

● Possible fluid overload and sodium imbalance. ● May indicate or be a sign of a cardiac problem.

To check for goiter, examine the patient's _____ through observation and palpation from the back

anterior neck

Deficiency associated with goiter

Iron

Most important examination of the neck area

Sternocleidomastoid Muscle (SCM)

Left SCM : Patient looks to the ___ Right SCM : Patient looks to the ___

Right, left

Neck Muscle Wasting may be a sign of _____

Protein deficiency

_______ of the shoulders can mean severe forms of energy or protein deficiency

Angulation

In shoulder assessment, assess the protrusion of the _____ of the scapula

Acromion process

Muscle loss is usually ____

Flaccid

The thoracic region is also known as the _____

Anterior Chest

Rachitic Rosary

- Rounded - Vitamin D Deficiency

Scorbutic Rosary

- Angular step-off deformity - Vitamin C Deficiency

Which is a more common deficiency in the country, Vitamin D or Vitamin C?

Vitamin D, so it is better to suspect the rachitic type

In inspection of back, inspect for _______

Prominence of Bones

For abdomen, look at the fat storage and rule out the presence of _____

Ascites

Note for any distention, enlargement, or bagginess in fat storage particularly above the _____

Umbilicus

Ascites Signs

Localized fluid accumulation in the abdominal cavity

Indication of ascites

If it moves like a balloon with water (parang umaalog) it may be ascites

Micronutrient Deficiencies associated in skin

- Iron - Copper - Vitamin A - Vitamin C - Vitamin K

Role of iron in skin

○ Involved in the transport and storage of oxygen ○ Involved in the production of RBCs, causing the skin to turn pale due to iron deficiency.

Role of copper in skin

Involved in iron metabolism and melanin pigment formation

Role of Vitamin A in skin

Regulates epithelium cell integrity

Role of Vitamin C in skin

Necessary for collagen synthesis in the major tissues of the skin

Role of Vitamin K in skin

Vital in blood clotting

Pallor is caused by _____

○ Iron deficiency ○ Folate deficiency ○ Vitamin B12 deficiency

In extreme cases of skin pallor

○ Biotin deficiency ○ Copper deficiency

Jaundice may be due to

Carotene excess (Carotenemia)

Follicular Hyperkeratosis is due to

Vitamin A deficiency

Pellagra Dermatitis Signs

- Hyperpigmented rash that is typically bilateral, symmetrical and limited to sun-exposed sites - Casal’s Necklace

Pellagra Dermatitis may be caused by

Niacin (B3) deficiency

Petechiae may be caused by Vitamin C deficiency. However, the most common cause in the country is ____

dengue

Easy Bruisability

- Vitamin C or K Deficiency

Acanthosis Nigricans is a manifestation of

insulin resistance

Instrument used to test handgrip strength

Handgrip Dynamometer

Epiphyses at The Wrists / Joints Signs

joint swelling and tenderness

Epiphyses at The Wrists / Joints may be due to ____

Vitamin C and D deficiencies

To check for interosseous muscles, palpate the muscle near the _____

metacarpal bone

Bowing of the Legs may be caused by

- Vitamin D deficiency (Blount’s disease) - Calcium deficiency

In quadriceps, inspect for ___

musculature

Bipedal edema is edema of the ______

Lower extremities

Bipedal anemia may be caused by

low protein in the body/blood caused by energy and protein deficiency

Features inspected in nails

Color, shape, texture

Pallor, Clubbing, Koilonychia causes

- iron deficiency and protein deficiency - can also be caused by heart diseases

Schamroth’s Window

absence of clubbing

Koilonychia

spoon-shaped nails

Transverse Ridging/Banding causes

Zinc deficiency (Beau’s lines)

Chronic protein deficiency (Muehrcke’s lines)

Very white transverse lines

Heavy metal poisoning is also called

Mee's Lines

In Hand-to-Toe (Skin) Examination, look for skin turgor to evaluate ____

Hydration status

What are the considerations in hair evaluation?

Ask about hair care practices to differentiate between lifestyle and nutritional issues.

Muscle and Fat assessment is done in what position

Sitting Position