Physical Exam

Physical (1 of 5 slides)

Physical (2 of 5 slides)

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

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.
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.
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.
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.
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/

Physical (5 of 5 slides)

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