Disease and conditions 

Rhinorrhea is the discharge of nasal mucus, ranging from clear to purulent or bloody, caused by infections, allergies, trauma, or structural abnormalities. Its evaluation involves history, nasal examination, and occasionally imaging or lab tests to identify underlying causes and guide treatment.

Retractions are visible chest wall indentations in infants and children indicating respiratory distress, often signaling increased work of breathing with accessory muscle use. Their location and severity help identify the underlying cause and guide urgent interventions.

Stertorous respirations are harsh, snoring-like sounds caused by partial upper airway obstruction, often seen in sleep apnea or airway edema. They signal potential respiratory compromise and require prompt assessment and airway management.

Shallow respirations are rapid, low-volume breaths that can signal respiratory distress or neuromuscular weakness, leading to inadequate oxygenation and possible cyanosis, confusion, or respiratory failure. Management includes assessing airway and breathing, providing oxygen, treating underlying causes, and monitoring for deterioration with interventions such as mechanical ventilation if needed.

Rectal pain is discomfort in the anorectal area, often caused by conditions such as anal fissures, hemorrhoids, perirectal abscesses, or anorectal fistulas. Evaluation includes inspection, history, and possibly anoscopic or endoscopic examination, with management focused on treating the underlying cause, relieving pain, and preventing complications.

Rebound tenderness, or Blumberg’s sign, is severe abdominal pain elicited when pressure on the abdomen is quickly released, indicating peritoneal inflammation or peritonitis. It requires prompt assessment, supportive care, diagnostic evaluation, and preparation for potential surgical intervention.

Raccoon eyes are bilateral periorbital bruising not caused by direct facial trauma, commonly indicating a basilar skull fracture or meningeal tear. They signal underlying cranial injury and require careful neurologic assessment, monitoring for cerebrospinal fluid leakage, and appropriate imaging and supportive care.

A pustular rash consists of pus-filled lesions that can be localized or widespread, often arising from infections, inflammatory skin disorders, or drug reactions. It may be associated with conditions like acne, folliculitis, impetigo, pustular psoriasis, or viral infections, and requires evaluation of underlying causes, infection control, and symptomatic management.

Purpura is the leakage of red blood cells from small blood vessels into the skin, subcutaneous tissue, or mucous membranes, appearing as purplish or brownish-red spots. It results from vessel damage, coagulation defects, trauma, medications, or underlying medical conditions.

A sluggish pupillary reaction is an abnormally slow response to light, often indicating cranial nerve (II or III) dysfunction, degenerative CNS disease, or ocular disorders. While not always life-threatening, it requires assessment of visual function, pupillary reflexes, and underlying systemic or ocular causes.

Nonreactive (fixed) pupils fail to constrict or dilate in response to light, indicating possible life-threatening emergencies such as brain herniation, oculomotor nerve palsy, or severe ocular disease. Prompt assessment of cranial nerve function, intracranial pressure, and ocular status is critical for timely intervention.

Pulsus paradoxus is an exaggerated drop in systolic blood pressure (>10 mm Hg) during inspiration, often signaling cardiac tamponade, severe asthma, or chronic obstructive pulmonary disease. Accurate detection requires careful blood pressure measurement or arterial pulse monitoring and prompts further cardiac or pulmonary evaluation.

Pulsus bisferiens is a double-peaked systolic pulse, often caused by aortic insufficiency, hypertrophic obstructive cardiomyopathy, or high-output states. Detection requires careful palpation, usually of the carotid artery, and its presence indicates the need for further cardiac evaluation.

Pulsus alternans is a beat-to-beat variation in pulse amplitude, usually indicating severe left-sided heart failure, and may be accompanied by a ventricular gallop. Detection requires careful palpation or sphygmomanometry, and its presence signals the need for urgent cardiac assessment and management.

Abnormal pulse rhythm indicates irregular arterial contractions, often reflecting underlying cardiac arrhythmias that may range from benign to life-threatening. Prompt recognition, ECG monitoring, and management are essential to prevent complications and maintain cardiac output.

A widened pulse pressure (>50 mm Hg) may result from physiologic states like fever or exercise, or pathologic conditions such as aortic insufficiency, arteriosclerosis, or increased intracranial pressure, and can indicate serious cardiovascular or neurologic compromise. Prompt recognition, monitoring, and treatment of underlying causes are crucial to prevent complications.

A narrowed pulse pressure, defined as a difference of less than 30 mm Hg between systolic and diastolic pressures, often occurs in late stages of shock, heart failure, or cardiac tamponade and reflects decreased cardiac output, increased peripheral resistance, or reduced intravascular volume. Early recognition and monitoring are critical to detect associated hypotension, poor perfusion, and declining level of consciousness.

A bounding pulse is a strong, forceful pulsation that can occur normally with exercise, pregnancy, or anxiety but may also signal fever, thyrotoxicosis, aortic insufficiency, or acute alcoholism. Assessment focuses on vital signs, cardiac rhythm, and identifying underlying metabolic or cardiovascular causes.

An absent or weak pulse may indicate shock, arrhythmia, or acute arterial occlusion, but can also result from benign factors such as palpation pressure or normally faint distal pulses. Rapid assessment of rate, amplitude, and symmetry, plus evaluation of associated symptoms, guides emergency management and identification of underlying causes.

Ptosis is the abnormal drooping of one or both upper eyelids, which can be congenital or acquired and may signal neuromuscular, ocular, or life-threatening conditions. Evaluation involves history, ocular examination, and addressing underlying causes, with treatment ranging from medical management to surgery.

Psychotic behavior is characterized by an impaired ability to recognize reality and relate to others, manifesting as delusions, hallucinations, bizarre language, or perseveration. Management involves ensuring patient and staff safety, evaluating underlying causes, providing appropriate medication, and facilitating psychiatric care and structured activities.

A positive psoas sign is increased abdominal pain with leg movement against resistance, usually indicating appendicitis or a localized abscess. Evaluation focuses on prompt recognition, monitoring for complications, and preparing the patient for surgery or further diagnostic testing.

Pruritus is an unpleasant itching sensation affecting the skin or mucous membranes, often caused by dermatologic, systemic, or drug-related conditions. Evaluation focuses on identifying underlying causes, avoiding triggers, managing symptoms with topical or systemic therapy, and educating the patient to minimize scratching.

Priapism is a persistent, painful penile erection unrelated to sexual activity, often caused by blood disorders, spinal cord injury, drugs, or penile cancer, and constitutes a urologic emergency. Management focuses on prompt pain relief, decompression of the corpora cavernosa, addressing underlying causes, and patient education to prevent complications.

Polyuria is excessive urine output often caused by endocrine, renal, neurologic, or psychiatric disorders, or certain drugs, and may lead to dehydration. Evaluation focuses on fluid balance, underlying causes, and patient education on hydration and symptom monitoring.

Polyphagia is excessive or voracious eating often caused by endocrine disorders (e.g., diabetes mellitus), psychological conditions (e.g., anxiety, bulimia), hormonal changes (e.g., PMS), or certain drugs, and may lead to weight changes. Evaluation involves dietary history, physical examination (including weight and thyroid assessment), identification of underlying medical or emotional causes, and appropriate counseling or referral for nutritional and psychological support.

Polydipsia is excessive thirst often caused by endocrine, renal, or psychiatric disorders, certain drugs, or electrolyte imbalances, and may be accompanied by polyuria, nocturia, and signs of dehydration. Evaluation involves detailed history, physical examination, monitoring fluid balance, and addressing underlying causes such as diabetes, hypercalcemia, or psychogenic factors.

A pleural friction rub is a coarse, grating lung sound caused by inflammation of the pleura, often associated with pleurisy, pneumonia, pulmonary embolism, or lung disease. It is best heard over the lower lung fields with the patient upright and may indicate serious respiratory pathology.

Photophobia is an abnormal sensitivity to light, which can result from ocular conditions, systemic disorders, trauma, or certain drugs. It may indicate mild issues, such as contact lens irritation, or serious conditions like corneal ulcers, uveitis, or meningitis, and requires careful history-taking, eye examination, and appropriate diagnostic evaluation.

Visible peristaltic waves are rippling movements across the abdomen that occur when the gut contracts forcefully, often in response to an obstruction in the stomach or intestines. They may also be seen in thin or malnourished patients, but when linked with pain, vomiting, or distention, they suggest pyloric or bowel obstruction and require prompt assessment and treatment.

A pericardial friction rub is a scratching or grating heart sound caused by inflamed pericardial layers rubbing together, most often signaling acute pericarditis. It is typically best heard at the lower left sternal border, may be triphasic, and requires careful evaluation for underlying causes and monitoring for complications such as cardiac tamponade.

Peau d’orange is the thickened, pitted appearance of breast skin resembling an orange peel, typically indicating advanced breast cancer. It can also occur with breast or axillary infections, and careful history, breast examination, and evaluation of axillary lymph nodes are essential for diagnosis and management.

Paroxysmal nocturnal dyspnea is a sudden, frightening attack of breathlessness that awakens a patient from sleep, often accompanied by coughing, wheezing, sweating, or chest discomfort. It most commonly signals left-sided heart failure, caused by increased pulmonary venous pressure when lying down, and requires prompt evaluation of cardiac and respiratory function.

Paresthesia is an abnormal sensation—such as numbness, tingling, or prickling—along peripheral nerve pathways, which may be transient or permanent. It can arise from neurologic, vascular, metabolic, infectious, traumatic, or drug-related causes, so thorough history-taking and neurologic examination are essential for diagnosis.

Psychotic behavior is a severe mental disturbance marked by delusions, hallucinations, bizarre language, and impaired reality perception, often resulting from psychiatric, neurologic, organic, or drug-induced causes. Management focuses on patient safety, reality orientation, structured activities, psychiatric evaluation, and appropriate pharmacologic therapy.

A positive psoas sign—abdominal pain elicited by hip flexion against resistance—indicates irritation of the psoas muscle, commonly due to appendicitis or retroperitoneal abscess. Management includes prompt assessment, monitoring for complications, preparation for surgical intervention if appendicitis is suspected, and patient education.

Pruritus is an unpleasant, often nocturnal itching sensation affecting the skin, mucous membranes, or eyes, caused by dermatologic, systemic, infectious, or drug-related conditions. Management includes identifying and treating the underlying cause, controlling symptoms with antihistamines or corticosteroids, and patient education to avoid scratching.

Priapism is a persistent, painful penile erection unrelated to sexual stimulation, often caused by sickle cell anemia, penile cancer, spinal cord injury, stroke, or certain drugs. It is a urologic emergency requiring prompt interventions to prevent ischemia and preserve erectile function.

Polyuria is the excessive production of urine, typically more than 3 L/day, and may result from endocrine, renal, neurologic, or psychological disorders, as well as certain drugs. Evaluation focuses on fluid balance, identifying underlying causes, monitoring vital signs and electrolytes, and providing guidance on fluid intake and disease management.

Polyphagia is excessive or voracious eating often caused by endocrine disorders, psychological conditions, or certain drugs, and may result in weight gain or metabolic complications. Evaluation involves assessing dietary habits, associated symptoms, underlying medical causes, and providing emotional, nutritional, and psychological support tailored to the patient’s needs.