Interactive Guide to Physical Examination
Glossary
Glossary

A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

labored breathing: Labored breathing due to any cause may necessitate the recruitment of accessory muscles of respiration. Note any supraclavicular retractions, intercostal muscle retractions, or contraction of the sternomastoids muscles or thoracoabdominal muscles. Go to page

lateralization: In a patient with hemiplegia, if there is tongue and/or facial weakness on the same side as the hemiplegia, the lesion must be above the CN VII and XII nuclei. In contrast, if the facial and/or tongue weakness is on the contralateral side, the lesion must be at the level of the nucleus or nerve. Go to page

left 2nd intercostal space, palpation of: A palpable impulse here is suggestive of an enlarged pulmonary artery due to severe pulmonary hypertension or increased flow such as in an atrial septal defect.

lethargy: The lethargic patient appears drowsy. He is however able to be aroused (with a loud voice or gentle shake) and will respond appropriately although tends to fall asleep quickly once the stimulus abates. Go to page

lid lag: Lid lag is the failure of the upper lid to follow smoothly the downward moving eye. As you ask the patient to follow your finger, slowly from an upward to downward position in the midline, you will notice that the lid lags behind the eye allowing for the appearance of a crescent of white sclera between the limbus and upper lid margin. Normally, the lid overlaps the iris slightly throughout the entire movement. Go to page

lift: a palpable cardiac apical impulse, more vigorous or longer than expected

lips:

color: With hypoxia and hypoperfusion the lips may look cyanotic or blue. In contrast, they may appear cherry red in the setting of carbon monoxide poisoning. Go to page

cracking: Fissures, or cracking of the skin at the angle of the lips is characteristic of angular cheilitis. This is commonly due to repetitive licking or moistening the corners of the mouth leading to maceration of tissue and often overgrowth of yeast. Go to page

scaliness: Carcinoma of the lip most commonly presents as an ulcer or nodule of the lower lip however can present as a scaly lesion. Go to page

lithotomy position: In the lithotomy position, the patient is lying on his back with his hips and knees flexed and thighs abducted and externally rotated.

liver:

consistency: The normal liver edge is liver is soft and smooth. If the edge feels hard or irregular this is indicative of infiltration of the liver with tumor. Go to page

nontender: Normally the liver is not tender to palpation. Many causes of enlargement of the liver may lead to tenderness. For example passive hepatic congestion such as with biventricular heart failure or inflammation due to any number of causes (infectious, neoplastic, infiltrative). In a patient with acute or chronic cholecystitis the gall bladder, and by virtue of its proximity the liver, may be tender with palpation. Go to page

pulsatility: The normal liver is non-pulsatile. Pulsatility may indicate significant tricuspid regurgitation with backflow to the liver or vascular malformation in the liver. Go to page

lower extremity: To measure the blood pressure in the lower extremity, it is important to use an appropriately sized thigh cuff, and auscultate over the popliteal fossae. This may be difficult, so alternatively, you may use an arm cuff just above the ankle and determine systolic blood pressure by palpation of the dorsalis pedis or posterior tibial artery. The blood pressure in the lower extremity may be equal to or slightly higher than the pressure in the arms. Go to page

lymph nodes:

consistency: The normal lymph node is firm in consistency. Lymph nodes that are hard tend to be associated with malignancy or post-inflammatory or post-infectious fibrosis. In contrast, lymph nodes that are rubbery in texture may be associated with leukemia or lymphoma. Certainly the consistency of the lymph node does not make the diagnosis but is one more characteristic that helps to distinguish benign processes from those with less benign outcomes. Go to page

mobility: Normal lymph nodes are freely movable. With pathologic involvement they can become "matted" to each other and form a mass that is not freely moveable. In addition, with cancer or inflammation they can become adherent to adjacent structures and thus fixed to underlying or adjacent tissue. Go to page

pathology: Lymphadenopathy of the cervical region can be due to local or systemic processes. It can be due to a vast variety of diseases (infections, inflammatory conditions, malignancy, and drug reactions). In evaluating lymphadenopathy of the neck it is important to determine if it is localized (involving just one lymph node chain in the neck or one drainage region) versus part of generalized lymphadenopathy (involving the axillary nodes, epitrochlear nodes, and inguinal nodes). Specific characteristics such as size, consistency, mobility should next be assessed. Go to page

size: Normal lymph nodes are usually less than 1 centimeter in size. The larger the size, the greater the likelihood of cancer. In one series, 38% of patients with lymph nodes greater than 2.25 cm squared had a diagnosis of malignancy whereas patients with lymph nodes less than one centimeter squared had no diagnosis of cancer made. Clinicians will often use the term "shotty" to describe small palpable lymph nodes. There is no special clinical significance of this term. Go to page

tenderness: Lymph node tenderness tends to suggest a more recent and rapid change in size. This can easily be seen with infectious causes, or hemorrhage into a node. This can however also be seen with cancerous involvement of a node. Go to page