Physical Exam

Physical (1 of 5 slides)

Physical (2 of 5 slides)

Which of the following physical findings are characteristic of iron deficiency anemia?

a
Scleral icterus
Scleral icterus may be seen in patients with hemolytic anemia, or in those with anemia associated with chronic liver disease. However, it is not a general finding in iron deficiency anemia.
b
Glossitis
Atrophic glossitis (in which the tongue appears red and smooth) is caused by atrophy of tongue papillae. It is reported in about 30% of patients with iron deficiency. It is a non-specific finding.
c
Angular cheilitis (cracking at the corners of the mouth)
Also called angular stomatitis, angular cheilitis is manifested by a grayish white thickening with adjacent erythema at the corners of mouth in early stages, and granulation tissues in later stages.
d
Purpura
Purpura may be a manifestation of a disorder of primary hemostasis (though there are many other causes). It is not a general finding in iron deficiency anemia.
e
Spoon-shaped nails (koilonychia)
Koilonychia is manifested by upward curving of the distal nail plate, resulting in a spoon-shaped nail. It is often associated with nail thinning and brittleness of the nails. Koilonychia is reported in only about 5% of patients with iron deficiency. You will more likely encounter this on a board exam than in a patient!

Physical (3 of 5 slides)

The following describes this patient’s physical exam:

Vital signs: Heart rate is 105/min, other vitals stable

Head and neck: Pale conjunctiva, tongue smooth along the edges

Chest: Normal to inspection, palpation, percussion, and auscultation

Abdomen: Non-tender, no hepatosplenomegaly

CNS: Grossly normal

Skin: Pale; nails cracked

Physical (4 of 5 slides)

Patient with iron deficiency anemia and angular cheilitis. From Zay Nyi Nyi/ Shutterstock.com

Physical (5 of 5 slides)

.Patient with iron deficiency anemia and ridged nails. From Toa55/Shutterstock.com