PATHOGNOMONIC SIGNS

Prepared By: John Gil B. Ricafort, BSN, RN

Diseases and Pathognomonic Signs
A Abdominal Aortic Aneurism - pulsating abdominal mass Abruptio Placenta - painful bleeding, board-like abdomen Acute Renal Failure - azotemia, uremic frost on skin

Addison’s Disease - bronze pigmentation of skin Angina Pectoris - pain upon exertion Appendicitis - Mc Burney’s sign Atrial Septal Defect - murmur heard high on chest Autism - rocking, spinning, routines

B Bacterial Vaginosis - grayish white discharges Basilar Fracture - raccoon’s eye Breech Birth - meconium staining Bulimia Nervosa - Binge eating

C Carbon Monoxide Poisoning - cherry pink flushed face, carbon in the secretions, non-productive cough Carpal Tunnel Syndrome - Jack Hammer Syndrome (TINEL’s sign) Cataract - cloudy vision Celiac Disease - gluten sensitivity, foul smelling stool

Chicken Pox - maculopopular rash Cholera - rice water stools Colic - pulling up of arms and legs, red-faced crying COPD - barrel chest, clubbing of fingers

Cushing’s Syndrome - moon face, buffalo hump CVA - homonymous hemianopsia Cystocele & Rectocele - feeling of fullness at vagina

D Delirium - recent and past memory defect Dementia - recall or learning memory impairment Detached Retina - flashes of light, shadow/ curtain across the vision DM - polydipsia, polyuria, polyphagia

Diptheria - pseudomembrane Diverticular Disease - cramping, colicky pain in left lower abdominal quadrant Down Syndrome (Trisomy 21) - saddle nose, brushfield’s spots

E Ectopic pregnancy - Cullen sign Endometriosis - premenstrual pain decreasing as menstrual flow decreases

F Failure to Thrive (FTT) - “Radar gaze”
G GERD - Barret esophagus Glaucoma - halos around the light, tunnel vision

Grave’s Disease - exopthalmia H Hemophilia - hemarthoses Hepatic Disease - asterixis, jaundice

Hirschprung’s Disease - ribbon-like, foul smelling stool H-mole - grapelike growth, large abdomen Hydrocephalus - Setting sun eyes Hypocalcemia - Trousseau sign, Chvostek Sign, Hyperreflexia

I Increased ICP - high pitch cry Increased IOP - Doll’s eye Intestinal Obstruction - no passage of meconium IDA - activity intolerance

K Kawasaki - strawberry tongue Kleibsiella Pneumonia - red gelatinous sputum
L Left-sided Heart Failure - pulmonary manifestations

Low birth weight - less than 2.5kg or 5 1/2lbs Lyme Disease - red-tinged circular rash (erythema chronicum migrans)
M Malaria - blackwater fever

Meniere’s Disease - whirling vertigo, tinnitus Meningitis - Kernig’s sign, Brudzinski’s sign Moniliasis - white “cheesy” discharge

Multiple Sclerosis - descending weakness, Charcot’s Sign (intention tremor, nystagmus, scanning speech) Myasthenia Gravis - nasal smile Mycoplasmal Pneumonia - nonproductive that progresses to mucoid sputum

Myocardial Infarction - Levine sign, viselike or crushing pain radiating to shoulder, arms, jaw or back
O Opthalmia Neonatorum - purulent conjunctivitis Oral Thrush - white patches on tongue

Osteoporosis - kyphosis Otosclerosis - ringing or buzzing, longer bone conduction than air conduction
P Pancreatitis - steatorrhea

PDA - machinery-type murmur throughout the heartbeat in the left 2nd or 3rd interspace Parkinson’s Disease - pill rolling, bradykinesia, rigidity Peritonitis - board-like abdomen Pernicious Anemia - Beefy red tongue

Pertusis - paroxysmal cough ending with a whoop PID - fever, vaginal discharges, lower abdominal cramping

Placenta Previa - painless bright red bleeding Pneumococcal Pneumonia - purulent rusty sputum Pneumothorax (Flail Chest) - paradoxical respiration – loose chest segment moves inward during respiration and outward during expiration

PIH - edema, proteinuria, hypertension Preterm infant - 36 weeks or less Prolapse Uterus - pelvic heaviness Pulmonary Embolism - sudden dyspnea, sharp pleuritic pain

Pyloric Stenosis - projectile vomiting, non bile stained vomitus, R Rabies - hydrophobia Retinoblastoma - diminished vision, strabismus, retinal detachment, abnormal pupilary reflex

Right Ventricular Failure - Systemic manifestation Rocky-Mountain Spotted Fever - rose colored macules Rubella (German Measles) - Foreschimer’s Spot (small red macules on soft palate) Rubeola (Measles) - Koplik spots

S Schizophrenia - Association, affect, ambivalence, autistic thinking Sickle Cell Anemia - “painful episodes” or “vaso-occlusive crisis” Staphyloccocal Pneumonia - yellow-blood streaked sputum

SIDS - frothy, blood-tinged fluid fills mouth and nose Syphilis - chancre on genitalia, mouth, anus SLE - butterfly rash on face

T Tetanus (lockjaw) - spasms TOF - Pulmonary valve stenosis, RVH, Overriding of the Aorta, VSD Thrombophlebitis - Homan’s sign Tracheoesophageal Fistula - coughing, choking, cyanosis

Trichomoniasis - malodorous thin yellow discharges Typhoid fever - rose-colored papules on the abdomen Tuberculosis - low grade fever, night sweats, hemoptysis

U Ulcerative Colitis - bloody, watery, purulent, mucoid stools
V Varicosities - tortous veins

VSD - low, harsh murmur heard throughout systole

Common Laboratory Values
Albumin 3.5-5.0 g/100 ml Ammonia 12-55 umol/L Amylase 4-25 units/ml

AST, SGOT Male: 8-46U/L Female: 7-34U/L Bilirubin Total: up to 1.0mg/100ml Bleeding Time 3-7 min BUN 8-25mg/ml

Calcium 8.5-10.5mg/100ml Carbon Dioxide 24-30mEq/L Chloride 100-106mEq/L Cholesterol <200mg/dl

Creatinine Kinase (CK) Male: 17-148U/L Female: 10-79U/L CPK <150U/L CPK-MB 0-5ng/ml Creatinine 0.6-1.5mg/100ml

ESR
Male: 1-13mm/Hr Female: 1-20mm/Hr Fibrinogen 160-450mg/dl Glucose 70-110mg/100ml HCO3 22-26mmol/L

HDL
30-75mg/dl Hemoglobin Male: 13-18g/ 100ml Female: 12-16g/ 100ml Hematocrit Male: 45-52% Female: 37-48%

Iron
50-150u/100 ml WBC -10,000-15,000/mm3 LDH 70-180 Lipase 2 units/ml or less

Magnesium 1.5-2 mEq/l pH 7.35-7.45 PO2 75-100mmHg PCO2 35-45mmHg

Phosphorus 3.0-4.5mg/ 100ml Platelets 150,000-400,000/mm3 Potassium 3.5-5mEq/l Protein 6.0-8.4g/ 100ml

PT
10-12 sec PTT

30-45 sec
RBC

Male: 4.6-6.2 million/ mm3 Female: 4.2-5.9 million/mm3 Sodium 135-145mEg/L

T3
75-195 ng/ 100ml T4, total 4-12 u/ml Thrombin Time 11-15 sec Triglycerides 40-150mg/ 100ml

TSH
0.5-5U/ml Urea Nitrogen 8-25mg/ 100ml Uric Acid Male: 4-9 mg/dl Female: 3-6.6 mg/dl

DIAGNOSTIC TESTS & PROCEDURES
Wag kalimutan…

Cardiovascular System

Electrocardiography - noninvasive test - graphical representation of the heart’s electrical activity - interpret EKG for changes

Holter Test Monitoring(Ambulatory EKG) - noninvasive test - records the heart’s electrical activity and cardiac events for 24 hours - advise the patient on activity limitations while wearing monitor

Cardiac Catheterization - invasive, fluoroscopic procedure - examines intracardiac structure, pressure, oxygenation and cardiac output. - Note the patient’s allergies before testing - Report immediately if with chest pain

Echocardiography - noninvasive test - uses echoes from sound waves to visualize intracardiac structures and blood flow - Determine the patient’s ability to lie still.

Stress Testing - noninvasive test - study of the heart’s electrical activity and ischemic events during levels of exercise. - Light breakfast before the test - STOP the test if patient develops cardiopulmonary symptoms

Respiratory System

Bronchoscopy - invasive test - allows for visualization of the trachea and bronchial tree - Check cough and gag reflex AFTER procedure

Pulmonary Angiography - invasive test involving injection of radiopaque dye - allows for radiographic examination of pulmonary circulation -NOTE allergies to iodine, seafoods, and radiopaque dyes BEFORE test

Thoracentesis - invasive procedure using needle aspiration - allows removal of pleural fluid and specimen examination - PLACE the patient in proper position

Pulmonary Function Tests (PFTs) - noninvasive test - measures lung capacity - Document bronchodilators or narcotics used before testing

Arterial Blood Gas analysis (ABG) - blood test - arterial blood measurements of tissue oxygenation, ventilation and acid-base balance. - APPLY pressure to the site 5 minutes after procedure

Lung Biopsy - invasive test - removal of a small amount of lung tissue for histologic evaluation - OBSERVE for signs of pneumothorax and air embolism after procedure

Nervous System

Electroencephalography (EEG) - noninvasive test - graphic representation of the brain’s electrical activity - WITHHOLD medications and caffeine 8 hours before the procedure

Cerebral Angiogram - invasive procedure using a radiopaque dye - allows examination for the cerebral arteries - NOTE patient’s allergies before the procedure

Lumbar Puncture - invasive test - collection of CSF for analysis - CONTRAINDICATED in the presence of increased ICP

Gastrointestinal System

Upper GI Series (Barium Swallow) - allows for examination of the esophagus, stomach, duodenum and other portions of the small bowel after swallowing - BEFORE procedure, administer fluids, cathartics, and enema, as prescribed

Lower GI Series (Barium Enema) - Allows for examination of the large intestine after administration of a barium enema - BEFORE procedure, withhold food

Endoscopy - procedure using an endoscope for visualization - WITHHOLD food and fluids 6 to 12 hours before the test

Fecal Occult Blood Test - laboratory test using a reagent - analysis of stool for blood - ADVISE the patient to AVOID red meat, iron and high fiber for 1 to 3 days prior to the procedure

Fecal Fat Test - laboratory test using a stain - analysis of stool for fat - ADVISE the patient to restrict alcohol intake and maintain a high-fat diet for 72 hours before examination

Cholangiography - invasive procedure using an injection of a radiopaque dye through a catheter - allows for examination of the biliary duct system - BEFORE the procedure, note the patient’s allergies

Liver Scan - invasive procedure using an IV injection of a radioisotope - provides an image of blood flow in the liver - Assess the patient for allergic reaction after the procedure

Gastric Analysis - aspiration of the contents of the stomach through an NG tube - measures the acidity of gastric secretions - Instruct NOT TO SMOKE for 8 to 12 hours before the test

Ultrasonography - noninvasive procedure that uses echoes from sound waves - provides visualization of body organs - WITHHOLD food and fluids for 8 to 12 hours before the procedure

Liver Biopsy - invasive procedure using needle for the percutaneous removal of a small amount of liver tissue - Before the test, assess clotting studies - During the test, hold the breath - After the test, Right lateral position

Urinary System

Urinalysis - laboratory test for urine - examines the color, appearance, pH, specific gravity, protein, glucose, ketones, RBCs, WBCs and casts - OBTAIN first morning urine specimen

Urine Culture and Sensitivity - laboratory test for urine - detects bacteria - Collect midstream sample in sterile container

24-hour Urine Collection - laboratory test for urine - samples collected over 24 hours to determine kidney function - instruct the patient to void and note time - discard the first urine collected

Blood Chemistry - laboratory test of blood sample - analysis for potassium, sodium, calcium, phosphorus, glucose, bicarbonate, BUN, creatinine, protein, albumin, and osmolality - check the site for bleeding

Cystoscopy - procedure using cystoscope to visualize the bladder - Check the patient’s urine for blood clots after the procedure

Renal Angiography - procedure using injection of radiopaque dye through a catheter - examination of the renal arterial supply - NOTE the patient’s allergies before the procedure

Hematopoietic System

Bone Marrow Examination - percutaneous removal of bone marrow - examines erythrocytes, leukocytes, thrombocytes, and precursor cells - GIVE analgesics or anxiolytics, as ordered.

Schilling Test - administration of oral radioactive cyanocobalamin and I.M. cyanocobalamin -microscopic examination of 24-hour urine sample of cyanocobalamin - WITHHOLD food and fluids post HS

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