Clinical Assessment- Part 1

Arifa Sultana
Lecturer
Department of Nutrition and Food Engineering
What are sign and symptom?
Flag sign
• Cause: Protein Energy Deficiency

Clinical features
The hair flag sign is characterized by alternating horizontal bands of
hypopigmentation of the hair (in children with kwashiorkor type of
protein-calorie malnutrition)
Nasolabial Seborrhea
• Cause: Pyridoxine, riboflavin or niacin deficiency.

Clinical Features
Nasolabial Seborrhea affects the nasal surface. In adolescents and
adults, it often presents as skin scaling (dandruff).
Bitot’s spot
• Cause: Vitamin A deficiency

Clinical features
Bitot's spots are a specific manifestation of Vitamin A deficiency. These
are triangular dry, whitish, foamy appearing lesions which are located
more commonly on the temporal side on the conjunctivae.
Conjunctival xerosis
• Cause: Vitamin A deficiency

Clinical features
Conjunctival xerosis (X1A, WHO classification) is usually bilateral and
reflects severe conjunctival dryness. It is a sign of long-standing vitamin
A deficiency (VAD). In advanced cases, the entire conjunctiva may
appear dry, roughened, thickened and corrugated, and sometimes skin-
like.
Keratomalacia
Cause: Vitamin A deficiency
Clinical Features
Keratomalacia is an eye (ocular) condition, usually affecting both eyes (bilateral),
that results from severe deficiency of vitamin A. That deficiency may be dietary
(i.e., intake) or metabolic (i.e., absorption). 
Early symptoms may include poor vision at night or in dim light (night blindness)
and extreme dryness of the eyes (i.e., xerophthalmia), followed by wrinkling,
progressive cloudiness, and increasing softening of the corneas (i.e.,
keratomalacia). With advancing vitamin A deficiency, dry, "foamy," silver-gray
deposits (Bitot spots) may appear on the delicate membranes covering the whites
of the eyes. Without adequate treatment, increasing softening of the corneas may
lead to corneal infection, rupture (perforation), and degenerative tissue changes,
resulting in blindness. 
Cheilosis
• Cause: Deficiency of riboflavin and niacin.

Clinical Features
The primary symptoms are redness, pain, and broken skin at the
corners of the mouth. The corners of the mouth may bleed or become
crusted over or scaly. Chapped lips and difficulty using your mouth for
talking and eating are also possible symptoms of cheilosis.
Angular Stomatitis
• Cause: Deficiency of riboflavin and niacin.

Clinical Features
Angular cheilitis is a common inflammatory condition affecting the
corners of the mouth or oral commissures. Depending on underlying
causes, it may last a few days or persist indefinitely. It is also
called angular stomatitis.
Magenta tongue
• Cause: Deficiency of riboflavin, pyridoxine and cobalamine.

Clinical Features
A purplish-red discoloration of the tongue due to vitamin B2 (riboflavin)
deficiency. It is also characterized by oedema and flattening of the
filiform papillae on the dorsum of the tongue.
Flurosis
• Cause: Toxicity of fluorine.

Clinical features
Symptoms of fluorosis range from tiny white specks or streaks that
may be unnoticeable to dark brown stains and rough, pitted enamel
that is difficult to clean.
Goiter
• Cause: Deficiency of iodine.

Clinical features
• A swelling in the front of the neck, just below the Adam's apple
• A feeling of tightness in the throat area
• Hoarseness (scratchy voice)
• Neck vein swelling
• Dizziness when the arms are raised above the head
Follicular Hyperkeratosis
• Cause: Vitamin A, niacin and/or vitamin C deficiency.

Clinical Features
Follicular hyperkeratosis, also known as keratosis pilaris (KP), is a skin
condition characterized by excessive development of keratin in
hair follicles, resulting in rough, cone-shaped, elevated papules. The
openings are often closed with a white plug of encrusted sebum.
Petechiae
• Cause: Deficiency of niacin, vitamin c or vitamin K.

Clinical features
Petechiae are pinpoint, round spots that appear on the skin as a result
of bleeding. The bleeding causes the petechiae to appear red, brown or
purple. Petechiae commonly appear in clusters and may look like a
rash. Usually flat to the touch, petechiae don't lose color when you
press on them.
Koilonychia
• Cause: Deficiency of Iron.

Clinical features
Spoon-shaped or spooning fingernails refers to a concavity in the
fingernail itself, resulting in a depression in the nail that gives an
appearance of a spoon shape to the entire nail. This growth
disturbance in the nail is medically known as koilonychia.
Craniotabes
• Cause: Deficiency of vitamin D

Clinical Features
Craniotabes is the softening of the bones of the skull.
Bow legs
• Cause: Deficiency of vitamin D

Clinical Features
Bow legs (or genu varum) is when the legs curve outward at the knees
while the feet and ankles touch.
Knock knees
• Cause: Deficiency of vitamin D

Clinical features
In knock knees, the lower extremities turn inward, causing the
appearance of the knees to be touching while the ankles remain apart.
Paresthesia
• Cause: Deficiency of vitamin B 12

Clinical features
Paresthesia refers to a burning or prickling sensation that is usually felt
in the hands, arms, legs, or feet, but can also occur in other parts of the
body. The sensation, which happens without warning, is usually
painless and described as tingling or numbness, skin crawling,
or itching.
Limitations
• Non-specificity of the physical sign.

• Multiple physical sign.

• Signs may be two directional.

• Examiner inconsistencies.

• Variation in the pattern of physical sign.

Thank You