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Normal adult resting respiratory rate is conventionally 12 to 20 breaths per minute. Rates below 12 indicate bradypnea, while rates above 20 indicate tachypnea. Interpretation should account for age and clinical context.
BMI 30 or above defines obesity; overweight is 25 to 29.9, normal is 18.5 to 24.9, and underweight is below 18.5. BMI is a screening measure and does not directly measure body fat.
A positive Babinski sign in an adult reflects loss of corticospinal inhibition and indicates an upper motor neuron lesion. The normal adult response is plantar flexion of the toes. Infants may have a positive sign until the corticospinal tract matures.
Kernig sign is positive when knee extension after hip flexion produces resistance or pain, suggesting meningeal irritation. Brudzinski sign is neck flexion causing hip or knee flexion. Obturator sign assesses pelvic irritation in appendicitis.
Jaundice becomes clinically visible when serum bilirubin is roughly 2.5 to 3 mg/dL. Lower levels may be biochemically abnormal but not visibly icteric. Higher levels produce more obvious jaundice but are not the threshold.
Normal fasting plasma glucose is 70 to 99 mg/dL. Impaired fasting glucose is 100 to 125 mg/dL, and a fasting value of 126 mg/dL or higher suggests diabetes when confirmed. Hypoglycemia thresholds are lower.
Capillary refill is considered normal when color returns within 2 seconds; prolongation beyond that may suggest poor peripheral perfusion. It is nonspecific and affected by ambient temperature. It is one component of the perfusion examination.
A 5-mm induration threshold is used for persons at highest risk, including HIV infection, recent close contacts, and immunocompromised patients. Lower-risk adults generally use a 15-mm threshold, while 10 mm applies to several moderate-risk groups. Induration, not erythema, is measured.
Mitral stenosis produces a low-pitched diastolic rumble heard best at the apex, often with an opening snap. The murmur follows the opening snap and may be accentuated by exercise. Systolic murmurs at the base or apex suggest different valve lesions.
Aortic stenosis causes a systolic ejection murmur that peaks in mid-systole and radiates to the carotids. It may be accompanied by a delayed and diminished carotid upstroke. Mitral regurgitation is holosystolic and radiates to the axilla.
Rovsing sign refers to right lower quadrant pain elicited by palpating the left lower quadrant, suggesting appendiceal irritation. McBurney point tenderness is a separate finding. Psoas and obturator signs assess local muscle irritation.
Murphy sign is inspiratory arrest during deep right upper quadrant palpation and supports acute cholecystitis. Courvoisier sign is a palpable, nontender gallbladder. Cullen and Grey Turner signs are periumbilical and flank ecchymoses seen in severe pancreatitis.
COPD classically produces a barrel-shaped chest with increased anteroposterior diameter, hyperresonance, and decreased breath sounds. These changes reflect hyperinflation and air trapping. Pneumonia and effusion more often produce dullness and focal findings.
Paroxysmal nocturnal dyspnea is a hallmark of left-sided heart failure, caused by pulmonary congestion when recumbent. Peripheral edema, jugular venous distension, and hepatomegaly reflect right-sided congestion. Orthopnea may accompany paroxysmal nocturnal dyspnea.
Nephrotic syndrome is characterized by heavy proteinuria, hypoalbuminemia, edema, and hyperlipidemia. Hematuria and hypertension are more typical of nephritic syndrome. Pyuria and dysuria suggest urinary tract infection.
A positive nitrite test depends on nitrate-reducing Gram-negative bacteria, most commonly Escherichia coli. Enterococcus and Staphylococcus saprophyticus do not reliably reduce nitrate. Candida is a fungus and does not produce a positive nitrite result.
Primary hyperthyroidism produces elevated thyroid hormone levels that suppress pituitary TSH, giving low TSH with high free T4. The opposite pattern suggests primary hypothyroidism. Low TSH with low free T4 suggests central hypothyroidism.
Diabetic ketoacidosis causes an anion-gap metabolic acidosis due to accumulation of ketone bodies. Bicarbonate is low, and compensatory hyperventilation lowers PaCO2. Hyperchloremic normal-gap acidosis is more typical after treatment or in other conditions.
Iron deficiency anemia is microcytic and hypochromic, with low ferritin reflecting depleted iron stores. Low MCV and low ferritin are the most useful screening pattern. B12 deficiency is macrocytic, while hemolysis raises reticulocytes and LDH.
Hyperkalemia typically produces tall, peaked T waves early, followed by QRS widening and sine-wave patterns as severity increases. Prominent U waves suggest hypokalemia. Prolonged QT can occur with hypocalcemia or hypokalemia.
Primary hyperaldosteronism is autonomous aldosterone secretion that suppresses renin, often causing hypertension and hypokalemia. Secondary hyperaldosteronism shows high renin with high aldosterone. Cortisol patterns relate to Cushing syndrome.
SIADH causes euvolemic hyponatremia with inappropriately concentrated urine and high urine sodium. Serum osmolality is low, and other causes of hyponatremia should be excluded. Hypovolemic hyponatremia usually has low urine sodium.
Acute pancreatitis is supported by characteristic epigastric pain plus lipase or amylase greater than three times the upper limit of normal. Lipase is more specific and remains elevated longer than amylase. Bilirubin elevation alone is nonspecific.
New temporal headache with jaw claudication in an older adult suggests giant cell arteritis, a vision-threatening vasculitis. ESR and CRP are often elevated, and high-dose corticosteroids should be started promptly when suspected. Temporal artery biopsy may confirm the diagnosis.
Carbon monoxide binds hemoglobin and is measured by carboxyhemoglobin, while standard pulse oximetry cannot distinguish carboxyhemoglobin from oxyhemoglobin. Patients may have a normal PaO2 and misleadingly normal oxygen saturation. Cherry-red skin is a late and inconsistent finding.
The knee jerk is a monosynaptic stretch reflex whose arc runs through L2–L4, with L4 contributing most; a depressed patellar reflex therefore suggests an L4 radiculopathy or a femoral nerve lesion. Comparing it with the biceps jerk (C5–C6) and the ankle jerk (S1) allows the examiner to localize the level of a root lesion.
The accepted criterion is a sustained drop of at least 20 mm Hg systolic or at least 10 mm Hg diastolic within 3 minutes of standing (or upright tilt). The finding reflects inadequate baroreflex compensation, commonly from volume depletion, autonomic neuropathy, or vasoactive medication.
A true positive Romberg sign appears only after eye closure, indicating that balance was being maintained by vision in place of lost proprioceptive input carried in the dorsal columns. Cerebellar and vestibular lesions characteristically produce unsteadiness even with the eyes open, which is why the test is performed both ways.
Rinne testing compares air conduction with bone conduction in the same ear; normally air conduction is heard longer (a positive Rinne). A conductive loss blocks the air pathway while bone-conducted sound still reaches the cochlea, so bone conduction outlasts air conduction and the test becomes abnormal (negative) in that ear.
Papilledema is passive bilateral disc swelling from elevated intracranial pressure, and central visual acuity is typically spared until the process is advanced. Optic neuritis is an inflammatory optic nerve lesion that reduces acuity early and is usually unilateral and painful with eye movement.
The positive likelihood ratio equals sensitivity divided by (1 minus specificity), and it multiplies the pretest odds to give the posttest odds. A value of 10 means a positive result makes disease roughly ten times more likely than it was before testing, a clinically important shift.
Traube's space is the normally tympanitic crescent over the gastric air bubble, bounded by the left costal margin, the sixth rib, and the midaxillary line. New dullness means something solid or fluid-filled has displaced that air, most often an enlarged spleen, and should be confirmed by palpation or imaging.
Pulsus paradoxus is an inspiratory systolic decline greater than 10 mm Hg. When pericardial pressure is high, right ventricular filling is impaired during inspiration and the septum bows toward the left ventricle, exaggerating the normal respiratory variation; in a patient with a large effusion this points to tamponade.
The palate is elevated by CN X, and when one side is weak the intact side pulls the uvula toward itself, so the uvula deviates away from the lesion. Deviation to the left therefore implies right-sided CN X weakness, whereas a CN XII lesion would cause the tongue to deviate toward the weak side.
The C6 dermatome includes the thumb and index finger. C5 supplies the lateral arm, C7 the middle finger, and C8 the little finger.
L5 innervates tibialis anterior and extensor hallucis longus, producing ankle dorsiflexion and great toe extension. L4 contributes to ankle dorsiflexion but not great toe extension as strongly, and S1 drives plantarflexion.
The biceps reflex is mediated primarily by the C5 root through the musculocutaneous nerve. C7 contributes to the triceps reflex, and T1 contributes to intrinsic hand muscles.
The S1 root mediates the ankle jerk and much of gastrocnemius-soleus plantarflexion. L4 is associated with the patellar reflex, while L5 is associated with dorsiflexion and great toe extension.
The straight leg raise tension sign commonly reproduces radicular pain from the lower lumbar roots, especially L4 through S1. Upper lumbar roots are better assessed with femoral stretch, and sacral roots do not produce a classic SLR response.
Spurling test narrows the cervical neural foramen and provokes radicular symptoms. Rotator cuff and peripheral nerve disorders are not reproduced by cervical extension and rotation.
The hip abductors, primarily gluteus medius and minimus, stabilize the pelvis during single-leg stance. Their weakness causes the contralateral pelvis to drop.
McMurray test loads the menisci during flexion and rotation and reproduces pain or clicking with meniscal tears. ACL and PCL integrity are assessed with drawer and Lachman tests, while MCL is assessed with valgus stress.
Upper motor neuron lesions produce disinhibition of the plantar reflex, causing an extensor Babinski response. Areflexia, fasciculations, and prominent atrophy are lower motor neuron findings.
Lower motor neuron lesions interrupt the final common pathway, producing atrophy, fasciculations, and hyporeflexia. Upper motor neuron lesions instead cause spasticity and hyperreflexia.
Myelopathy reflects cord compression and produces upper motor neuron signs such as spastic gait, hyperreflexia, and Babinski sign. Radiculopathy tends to produce dermatomal pain, reflex loss, and a positive Spurling test.
Lhermitte sign is an electric shock-like sensation evoked by neck flexion and suggests dorsal column or cervical cord irritation. Hoffmann and Babinski are upper motor neuron signs, and Romberg assesses proprioceptive balance.
Cauda equina syndrome classically causes saddle anesthesia, bowel or bladder dysfunction, and bilateral lower extremity symptoms. It is a surgical emergency requiring urgent MRI.
The Lachman test assesses anterior tibial translation with the knee slightly flexed and is the most sensitive clinical test for ACL insufficiency. McMurray assesses menisci, posterior drawer assesses PCL, and valgus stress assesses MCL.
The posterior drawer test detects posterior translation of the tibia relative to the femur, reflecting PCL insufficiency. ACL injury is assessed by Lachman or anterior drawer testing.
The drop arm test reflects supraspinatus dysfunction, because this muscle initiates and maintains early arm abduction. Infraspinatus and teres minor are external rotators, and subscapularis is an internal rotator.