Clinical evaluation tools Flashcards
What is the rule of three?
Looking for a minimum of 3 indications that support your hypothesis.
What are the 3 main structures of a nail?
- The nail plate
- The nail bed
- The cuticle
What 3 indications may nails give us?
- overall vitality (strength & quality)
- Occupations and hobbies
- Nutritional status
What is paronychia and what may it indicate?
Nail infection around the nail. Caused by: Stress, trauma poor nutrition low immunity poor hygiene
What can wicks or hangnails be due to?
Too little protein, lack of vit B and vit C.
What may nail dryness indicate?
Low EFAs, low vit A and D or low thyroid condition.
Excessive use of chemical detergent, irritants and hand washing may indicate?
Need for nervous system/adrenal support or may be due to occupational hazards.
What is clubbing (Schamroth’s sign)?
Involves a softening of the nail bed with the loss of normal angle between nail bed and the fold. If you can see a diamond space between them (Schamroth’s sign) then the nails are not clubbed.
What are 3 causes of clubbing?
- Pulmonary and Cardiovascular (80%)
- Gastrointestinal (5%)
- Hyperthyroidism (1%)
What is koilonychia?
spoon shaped concave nails
Which age group does koilonychia normally appear in?
Children, usually resolves with aging.
What test can we perform to see if a nail is spooned?
Water drop test - if water doesn’t slide off nail is spooned.
Name 3 conditions spooned nails can indicate?
- Iron deficiency
- diabetes mellitus
- Haematomachrosis
In Beau’s nails the location and depth of transverse lines indicate what?
The approximate date and severity of the illness.
Name 3 illnesses producing Beau’s lines?
- Severe infection
- Hypotension, shock
- Hypocalcaemia
Along with transverse lines, what other appearance is there in Beau’s lines?
Beau’s Growth Arrest Line
Name 3 things thin brittle nails may indicate?
- Metabolic bone disease
- Thyroid disorder
- Severe malnutrition and common mineral deficiency
Name 3 deficiencies associated with central longitudinal ridges?
- Iron deficiency
- Folic acid deficiency
- Protein deficiency
Which nail is central nail canal normally present?
Thumbs
What 3 conditions are associated with central nail canal?
- Malnutrition
- Repetitive trauma
- Severe arterial disease
What type of deformity can appear with central nail canal?
Fir Tree deformity
What is the main cause of nail pitting?
Nail matrix inflammation due to psoriasis and eczema.
Can you describe nail beading?
The beads seem to drip down the nail like wax.
What condition is nail beading associated with?
Endocrine (diabetes mellitus, thyroid, addison’s disease)
Name one condition to consider when nails look sandpapered and dull.
Autoimmune disease
Identify 3 possible causes of nail thickening.
- Slowed nail growth
- Onychomycosis (fungal nail infection)
- Chronic eczema
What is onycolysis?
Distal separation of the nail plate from the underlying nail bed.
Name 3 conditions associated with onycolysis?
- Eczema
- Psoriasis
- Contact dermatitis
What should be investigated if lunula is absent from the thumbs?
Anaemia or malnutrition
What would a pale blue lunula suggest?
Diabetes mellitus
Why should we take a urine specimen mid stream?
Because when urine is exposed to air, it starts to be broken down by bacteria that contaminate it from the outer part of the urinary tract and the skin.
What are the salts in the urine converted into?
Ammonia which have a powerful smell.
Very dark yellow, orange or brown urine may be a sign of?
Jaundice
How often should a saliva test be repeated?
Three times a day (an hour after brushing teeth, before lunch and before evening meal) for 4-5 days in succession.
What can white nails be caused by?
anaemia
oedema
vascular conditions
White spots on nails like paint are linked to what?
calcium deficiency
What is the cause of transverse white lines (Mee’s Lines) across nails?
Acute illness, heavy metal toxicity or chemotherapy
What is distinctive about Terry’s nails?
The tip of the nail has a darker band.
What is the whiter part of Terry’s nails related to?
oedema or anemia
What condition may be related to Terry’s nails?
Renal or liver disease
Name 3 conditions pink or red nails may be caused by?
- Malnutrition
- Carbon monoxide
- Polycythemia (dark) - increased concentration of haemoglobin in the blood
Name 3 conditions brown grey nails may suggest?
- cardiovascular disease
- diabetes mellitus
- Vit B12 deficiency
In TCM, why is the tongue considered to be an exterior part of the body?
Because it is in almost contact with air (the exterior)
What does the TCM tongue map represent?
The internal organs
Where would you find the heart on the tongue map?
Tip of tongue
What would a healthy tongue look like?
A kittens tongue, pink, free of cracks and moist with a thin clear or white coat.
What is Qi?
An energy/life/vital force
Thin Tongue
weakness or deficiency
Swollen tongue
dampness
Scalloped tongue (teeth marks on sides)
weakness in digestion, fatigue
Pale tongue
reduced qi/coldness
Red tongue
Inflammation/infection
Red and painful tongue
Deficiency of B1, B12 or folate
Magenta tongue
B2 deficiency
Purple tongue
Blood stagnation/reduced qi/poor ciculation
Under the tongue -high red
inflammation/excess animal foods
Under the tongue - blue/green
Disorder of blood vessels due to animal fats
Under the tongue -yellow
Excessive bile secretion or excessive dairy/mucus/stagnation
Under tongue -Deep purple
Drugs, medication, chemicals and sugar causing lymph/blood vessel disorder
What are cracks on the tongue called? What sign is this showing?
Fissures
Long-term health problems
A medical fissure - crack through middle of tongue, not to tip may be a sign for?
Deficiency of digestion, requiring B vits, esp B12 and folate. It may also indicate iron deficiency and under secretion of HCL and pepsin.
A medical fissure -crack running to tip and pronounced deep may represent what?
Heart condition
In ayurvedic tongue diagnosis, what does the mid line of the tongue represent?
Spine
In ayurvedic tongue diagnosis, what does the tip of the tongue represent?
Top and back of bottom
Cracks all over the tongue represent?
B2 deficiency often seen in psoriasis sufferers
When might you see a hairy tongue? What can you suggest?
Following antibiotic treatment. Probiotics and prebiotics required
A thick, damp coated tongue may mean?
mucous production, dampness, congestion due to refined carbohydrates, dairy and sugar intake
A sticky and moist tongue may mean?
Extreme dampness of stomach/spleen
White coating of tongue
cold, deficient
Dark brown coating of tongue
some form of stagnation
Slimy tongue
Phlegm, mucous, damp
Yellow tongue
Heat, excess, if thick can be dampness
Black tongue
Indicates severe form of heat, if over digestive area - chronic constipation.
No coat, shiny tongue
Possible deficiencies, exhaustion of energy, weak digestion
Dry tongue
Heat excess,not enough fluids or not holding fluids - consider mg and omega 3s.
Impaired taste
zinc deficiency
Name 3 things dampness of the tongue can be caused by?
- Diet (bananas, dairy, sugar)
- Environment (damp house)
- Tiredness (regardless of sleep)
Quivering tongue
Tremor - indicates mg deficiency
What is cheilosis? Which deficiencies can this relate to?
A dry scaling and cracking of the red surface of the lips
B2, B3 and folate
What is angular stomatosis? Whcih deficiencies can this relate to?
Manifests as reddened cracking and scaling in the corners of the mouth
B2, B3, B6, B12, folic acid and iron
Bleeding gums (also receding)
Vit C deficiency and/or zinc, CoQ10. Consult dentist to rule out peridontal disease
Gingivitis represents what about the diet?
Diet too acidic
Peridontal disease
High acidity, low bioflavonoids, zinc and CoQ10
Pale mucous membranes (gum)
Iron deficiency
Greyish mucous membranes
Biotin defciency
Describe a yin face?
Large and broad at the forehead, narrow at chin. Large eyes with widely spaced arched eyebrows, narrow bridge of the nose and paler skin
Describe a yan face?
Round to square face, the broader the jaw the more yang the face. Wide nose and mouth with medium to small eyes. There is often high colour in yang face.
Which syndrome relates to an extreme round face?
Cushing’s syndrome
Blue/black shadows under eyes (bags)
fluid retention and kidney/adrenal exhaustion
Redness on cheeks
Marker for food allergies
Receding hair line
decreased function of gallbladder
‘Purse strings’ on upper lip
Often seen in menopausal women - weakness in reproductive organs.
May also be a sign of smoking
Bitot’s spots
Vit A past or present deficiency
Dry eyes
Vit A, EFAs
Night blindness
Vit A, zinc
Pale conjuctiva
Iron
Blue sclera
Iron
Retinal haemmorrhage
Iron
Photophobia
Vit B2, B3, zinc
Lack of eyelashes
Copper
Premature greying
Vit B12, protein, biotin
Nasolabial derrmatitis
Vit B2
Butterfly rash around nose (deficiency & poss condition)?
Vit B3 or linked to acne rosacea or lupus
Painful scaly, greasy red rashes on ears and eyelids
Vit B2
Cyanosis in cold weather
Protein
Thin dull grey skin
Protein
Pallor
Vit B12, folate, biotin
Hair loss
EFAs, iron, selenium, protein
Thinning hair with loss of colour
Biotin
Brittle, dry and lustreless hair
Iron, protein
Garlic breath
Selenium
Metallic taste
Selenium
Oedema
Vit E
Perifollicular hyperkeratosis
Vit A, B complex, EFAs, Vit C
What is an exudate?
Any fluid that filters from the circulatory system into lesions or areas of inflammation
What does a clear blister compose of?
An exudate that contains water (and solutes), together with some plasma proteins, but not many blood cells.
What does pus compose of?
Exudate found in infected wounds that also includes bacteria and high concentrations of WBCs.
What is Blood pressure?
The pressure of the blood inside the arteries
What is high BP associated with?
Stress, obesity, inactivity, hormonal disruptions and risk factor for stroke, heart and kidney failure.
Low BP may be associated with stress. Which group of people tend to have a lower BP?
Vegetarians and healthier people - associated with decreased mortality.
A BP reading should be taken for every child over what age?
2 years old
Ideally what should a patient avoid before having a BP taken?
Smoking and drinking caffeine 30 mins prior to BP taken.
3 signs of hypertension
headaches
dizziness
flushing
3 signs of hypotension
dizziness on standing
weakness
visual disturbance
Stool very pale/clay colour
insufficient production of bile
Green stools
release of toxic matter from the gallbladder
white mucous in stools
indicates disturbance of intestinal flora, infection, an immune response
very dark brown stools
slow transit time in colon; hyperactive thyroid
orange coloured stool
insufficient bile or lipase insufficiency
black tarry stool
Red Flag! can be indicative of cancer. May be due to blood from GI tract.
red/maroon stools/blood in stools
Red Flag! Refer patient to medical doctor
Floating stools
Fats in diet not emulsified properly by the bile.
Sinking stools
Heavy with decaying matter or unused minerals
Thin stools
Tension (colon is in contractile state)
Dry stools
Poor water intake; slow transit time - poor fibre, hypothyroid, stress
How does The TCM body clock work?
Qi circulates in a distinct pattern
The vital energy moves from organ system to organ system giving it fuel to function.
Every organ in our body takes an active role at a given time of the day. The opposite oran in the clock is at it’s lowest ebb at that time.
