Glossary of physical examination

• 22q11.2 deletion syndrome - A congenital anomaly characterized by immunodeficiency, abnormal facies, congenital heart disease, hypocalcemia, and increased susceptibility to infections. Pathologic characteristics include conotruncal abnormalities and absence or hypoplasia of thymus and parathyroid glands. DiGeorge syndrome is associated with abnormalities of chromosome 22. Also known as DiGeorge anomaly.

• 504 plan - Indicates that a person has been educated through a plan created under section 504 of the Rehabilitation Act which prohibits discrimination against individuals with disabilities and allows for accommodations for the child to be able to achieve academic success in primary or secondary school.

• Abdominal aorta - The portion of the descending aorta that lies within the abdomen, beginning below the diaphragm and ending at its division into the right and left common iliac arteries.

• Abdominal auscultation finding - A finding noted on auscultation of the abdomen.

• Abdominal bruit present - An indication that auscultation of the major arteries of the abdomen demonstrates the presence of turbulent vascular sounds.

• Abdominal examination - An assessment of the abdomen including the organs within the abdominal cavity.

• Abdominal pain - Painful sensation in the abdominal region.

• Abdominal palpation finding - A finding noted on palpation of the abdomen.

• Abdominal visual inspection - A visual assessment of the abdomen.

• Abnormal cardiac event monitoring finding - A history of having had an abnormal finding during cardiac event monitoring.

• Abnormal cardiac study - A history of having had an abnormal cardiac study.

• Abnormal chest radiograph - A history of having had an abnormal chest radiograph.

• Abnormal echocardiogram - A history of having had an abnormal echocardiogram.

• Abnormal electrocardiogram - A history of having had an abnormal electrocardiogram (ECG).

• Abnormal holter monitoring finding - A history of having had an abnormal finding during Holter monitoring.

• Abnormal s1 heart sound - An auscultated finding in which the components of the first heart sound are not normal.

• Abnormal s2 heart sound - An auscultated finding in which the semilunar valve closure sounds are not normal.

• Abnormally displaced point of maximum impulse - A clinical finding in which the point of maximum impulse is located lateral to the anticipated position in the left midclavicular clavicular line, fifth intercostal space.

• Abnormally located point of maximum impulse - A clinical finding in which the point of maximum impulse is located in a place other than the left anterior chest.

• Acral edema - Accumulation of an excessive amount of watery fluid in cells or intercellular tissues of the hands and feet.

• Acral erythema - Reddening of the palmar and plantar regions of the body with occasional involvement of the distal extremities.

• Acrocyanosis - Persistent, symmetric, and painless blue discoloration of the extremities. It is the result of vasospasm in response to cold. The affected areas are cold and sweaty.

• Activity associated with chief complaint - Any associated activity noted when chief complaint occurs or that induces onset of the chief complaint.

• Adenoidectomy - Surgical removal of the pharyngeal tonsils (adenoids).

• Adequacy of daily caloric intake - The appropriateness of daily caloric intake for a given patent based primarily on age and energy requirements.

• Adequacy of daily fluid intake - The appropriateness of daily fluid intake for a given patent.

• Adequacy of salt intake - The appropriateness of daily salt intake for a given patent.

• Adequate daily caloric intake - The daily caloric intake is sufficient.

• Adequate daily fluid intake - The daily fluid intake is sufficient.

• Adequate daily salt intake - The daily salt intake is sufficient.

• Age at diagnosis of congenital heart disease - The age of the patient when congenital heart disease was diagnosed.

• Alanine aminotransferase measurement - A quantitative measurement of alanine aminotransferase present in a sample.

• Alcohol use history - A description of an individual's current and past experience with alcoholic beverage consumption.

• Alleviating factor to chief complaint - Any factor that lessens or improves the chief complaint.

• Angina - Paroxysms of chest pain due to reduced oxygen to the heart.

• Anorexia nervosa - A disorder most often seen in adolescent females characterized by a refusal to maintain a minimally normal body weight, an intense fear of gaining weight, a disturbance in body image, and, in postmenarcheal females, the development of amenorrhea.

• Anterior chest examination - Inspection of the region encompassing the anterior surface of the chest and epigastrium.

• Anticongestive medications given for rheumatic fever - An indication that anticongestive medications were given as treatment for rheumatic fever.

• Anti-ulcer agent - Natural or synthetic Anti-ulcer Agents relieve and reduce the symptoms of ulcers in the stomach and upper small intestine, systemically and locally, by reducing gastric secretion (proton pump inhibitors), neutralizing hyperacidity (alkalinizing agents), or improving healing and protecting the mucosa (sucralfate). Recurrent gastric and duodenal ulcers caused by Helicobacter pylori infections are treated with antibiotic therapy.

• Appearance of extremities - An assessment of the appearance of the upper and lower extremities.

• Arrhythmogenic syncope - A condition in which syncope occurs due to an arrhythmia.

• Arthralgia - Pain in a joint.

• Ascites - The accumulation of fluid in the peritoneal cavity, which may be serous, hemorrhagic, or the result of tumor metastasis to the peritoneum.

• Aspirin given for kawasaki disease - An indication that aspirin was given as treatment for Kawasaki disease.

• Aspirin given for rheumatic fever - An indication that aspirin was given as treatment for rheumatic fever.

• Asymmetric chest appearance - Inspection of the region of the anterior surface of the chest and epigastrium reveals disparate configuration on opposite sides of a vertical central dividing line.

• Asymptomatic presentation - A clinical description in which a patient does not demonstrate evidence of clinical findings to suggest underlying pathology.

• Becker's muscular dystrophy - An X-linked inherited disorder characterized by slowly progressing weakness in the muscles of the legs and pelvis.

• Bed rest - Confinement of an individual to bed for therapeutic reasons.

• Birth - The event of being born.

• Blowing heart murmur - A heart murmur that has an auditory quality similar to the sound of a person blowing air.

• Body mass index - An individual's weight in kilograms divided by the square of the height in meters.

• Body surface area - A measure of the 2-dimensional extent of the body surface (i.e., the skin). Body surface area (BSA) can be calculated by mathematical formula or from a chart that relates height to weight. BSA is often an important factor in dosing.

• Body temperature measurement - The result of the measurement of the body temperature.

• Body weight - The weight of a subject.

• Brachial artery - An artery originating at the axillary artery and branching into the radial and ulnar arteries.

• Breath holding - Episodic apnea, which is more common in young children and usually resolves by age six.

• Burning chest pain - The sensation of chest pain described as an intense discomfort, similar to that experience as a result of a thermal burn, distinct from sharp, stabbing or aching, often related to nerves; sometimes used to describe gastric or esophageal pain.

• Caffeine not routinely consumed - An indication that the patient does not consume caffeine on a regular basis.

• Caffeine routinely consumed - An indication that the patient consumes caffeine on a regular basis.

• Capillary refill test - An assessment performed to estimate peripheral perfusion and hydration status. The test is most often conducted by applying constant manual pressure for a set time on a patient's nail bed and then releasing while observing the length of time it takes for color to return to the tissue. A prolonged return to baseline coloring may indicate compromise of peripheral blood flow.

• Cardiac ablation - A procedure intended to eliminate or modify a focus or re-entry circuit that causes an arrhythmia in the heart. (ACC)

• Cardiac catheterization - A procedure in which a thin plastic tube (catheter) is inserted into an artery or vein in the arm or leg and then advanced into the chambers of the heart or into the coronary arteries. Catheterization can measure blood pressure within the heart and how much oxygen is in the blood. It's also used to get information about the pumping ability of the heart muscle. Catheters are also used to inject dye into the coronary arteries. Catheters with a balloon on the tip are used in the procedure called percutaneous transluminal coronary angioplasty.

• Cardiac disease screening - An evaluation to determine whether an individual has any current condition that affects the heart.

• Cardiac electrophysiology study - A cardiac procedure performed under fluoroscopy to determine the area of the heart that is the source of aberrant electrical impulses that give rise to arrhythmias. Aberrant pathways can be terminated by ablation.

• Cardiac radiofrequency ablation - The use of radiofrequency energy to destroy an area of heart tissue that is causing an arrhythmia. It is administered via catheterization.

• Cardiac surgery - A surgical procedure on the heart.

• Cardioinhibitory syncope - A condition in which neurally-mediated syncope occurs in which the blood pressure falls and heart rate falls.

• Cardiomegaly - Abnormal enlargement of the heart.

• Cardiovascular examination - Tests and assessments pertaining to the cardiovascular system.

• Carditis - Inflammation of the heart or its surroundings.

• Carotid artery - One of two arteries that supply oxygenated blood to the head and neck; the left common carotid branches from the aorta and the right common carotid from the innominate (brachiocephalic artery).

• Carotid bruit - An innocent murmur with a medium pitched, harsh character heard at the right or left upper sternal border, supraclavicular region, or anterior portion of the lower neck that disappears with bilateral shoulder hyperextension.

• Carotid sinus syncope - A condition in which neurally mediated syncope occurs due to massage of the carotid body.

• Carpal spasm - A spasmodic contraction of the muscles of the hands, especially the wrists, such as during alkalosis or tetany.

• Central venous cannula insertion - A procedure of surgical placement of a catheter, which lumen is usually occupied by a trocar, into the central vein (internal jugular, subclavian, and femoral often used) or veins, to provide vascular access for measurement of hemodynamic variables that cannot be measured accurately by noninvasive means. It also can be used to deliver medications that were too potent or too toxic to be administered through peripheral access, for parenteral nutrition delivery; and for placing wires and pulmonary artery catheters. Central veins are usually cannulated percutaneously. The procedure is associated with many adverse events and has to be performed or supervised by an experienced physician.

• Change to upright position - The state of going from a supine or seated position to a standing position.

• Charge syndrome - A rare autosomal dominant syndrome usually caused by mutations in the CHD7 gene. The term CHARGE is an acronym for the following unusual congenital abnormalities that are associated with this syndrome: coloboma of the eye, heart defects, choanal atresia, growth and developmental retardation, genital, and ear abnormalities.

• Cheilitis - An inflammatory process affecting the lip.

• Chronic orthostatic intolerance - A condition in which there is orthostatic intolerance lasting for at least three months with associated functional impairment.

• Clubbing of fingers - An abnormal enlargement of the terminal phalanges accompanied by increased length-wise curvature of the nails, giving the digits a club-like appearance. Clubbing has been noted with a wide variety of conditions, including pulmonary and cardiac diseases, liver disorders, and disorders of the gastrointestinal tract.

• Cold sensation - An internal feeling of being cooler without a concomitant change in the ambient environment.

• College completion - Indicates that a person has attended college and receive a degree.

• Comorbidity - The coexistence of two or more disease processes.

• Complex breath holding - A clinical condition in which there is a breath-holding spell associated with syncope.

• Computed tomography of the heart - Non-invasive imaging of the heart utilizing computed tomography (CT).

• Conjunctivitis - Inflammation of the conjunctiva of the eye.

• Continuous heart murmur - A heart murmur that occurs throughout both systole and diastole.

• Continuous with diastolic spillover heart murmur - A heart murmur that occurs throughout systole and the early part of diastole.

• Coronary artery aneurysm - Focal dilation of a coronary artery secondary to arterial wall weakening.

• Coronary artery ectasia - Diffuse dilation of a coronary artery segment.

• Coronary microvascular disease - A disorder affecting the smallest coronary arteries. Causes include atherosclerosis and arterial spasm. Chest pain is a frequently observed symptom.

• Cough - A sudden, often repetitive, spasmodic contraction of the thoracic cavity, resulting in violent release of air from the lungs, and usually accompanied by a distinctive sound.

• Coumadin given for kawasaki disease - An indication that coumadin was given as treatment for Kawasaki disease.

• C-reactive protein measurement - A quantitative measurement of the amount of C-reactive protein present in a sample.

• Cryoablation for arrhythmia - The use of cold to freeze heart tissue that is a source of an irregular rhythm. It is administered via a balloon catheter that use advanced radiographic techniques.

• Current every day smoker - Indicates a person who has smoked at least 100 cigarettes in his or her lifetime and who currently smokes every day.

• Current some day smoker - Indicates a person who has smoked at least 100 cigarettes in his or her lifetime, who smokes now, but does not smoke every day.

• Cyanosis - A bluish or purplish discoloration of the skin and mucous membranes resulting from a reduced concentration of oxygenated hemoglobin in the blood.

• Cyanotic breath holding - A clinical condition in which there is a breath-holding spell associated with cyanotic appearance.

• Date of patient evaluation prior to current chief complaint - The date of the prior clinical assessment of the patient for the current chief complaint.

• Decreased exercise tolerance - A reduction in the ability to perform or withstand activities that induce physical or mental exertion.

• Defecation - The normal process of elimination of fecal material from the rectum.

• Dehydration - A condition resulting from the excessive loss of water from the body. It is usually caused by severe diarrhea, vomiting or diaphoresis.

• Delayed capillary refill time - A clinical finding in which a capillary nail refill test returns to pink color in greater than two seconds after pressure is removed.

• Desquamation - Shedding of the outer layer of skin or mucosal tissue.

• Developmental delay - Failure to meet, or late achievement of developmental milestones.

• Developmental finding - Symptoms, physical examination results, and/or laboratory test results related to physical, emotional, behavioral, or social development.

• Diagnosis at patient evaluation prior to current chief complaint - The diagnosis given at the prior clinical assessment of the patient for the current chief complaint.

• Diaphoresis - Profuse sweating.

• Diastolic heart murmur - A heart murmur that occurs between ventricular ejection, while the semilunar valves are closed.

• Digestive system finding - Symptoms, physical examination results, and/or laboratory test results related to the digestive system.

• Dizziness - A sensation of lightheadedness, unsteadiness, turning, spinning or rocking.

• Dorsalis pedis artery - An artery of the dorsal surface of the foot, originating from the anterior tibial artery of the lower leg. The following arterial branches originate from the dorsalis pedis artery: the arcuate artery of the foot and deep plantar artery.

• Drug-induced syncope - A condition in which syncope occurs due to the ingestion or administration of a chemical substance.

• Duchenne muscular dystrophy - An X-linked inherited disorder caused by mutations in the DMD gene found on the X chromosome. It is characterized by rapidly progressing muscle weakness and muscle atrophy initially involving the lower extremities and eventually affecting the whole body. It affects males whereas females can be carriers. The symptoms start before the age of six and may appear at infancy.

• Dull chest pain - The sensation of chest pain described as a mild or blunted discomfort.

• Duration of chief complaint - The length of time that the chief complaint persists.

• Dysautonomia - An acute or chronic disorder, affecting the sympathetic or parasympathetic nervous system. It can be primary, the result of central nervous system degeneration, or secondary due to diabetes or alcoholism. Patients with the chronic form of this disorder usually have a progressive clinical course and a poor prognosis.

• Dyspnea - An uncomfortable sensation of difficulty breathing. It may present as an acute or chronic sign of an underlying respiratory or heart disorder.

• Early systolic heart murmur - A heart murmur that occurs during the early portion of the ventricular ejection phase.

• Echocardiogram - An image of the heart produced by ultrasonography.

• Edematous scrotum - An indication that on visual inspection the scrotal skin is found to have become taut due to excessive fluid.

• Education level - An indication of the years of schooling completed in graded public, private, or parochial schools, and in colleges, universities, or professional schools.

• Ehlers-danlos syndrome - An inherited connective tissue disorder characterized by loose and fragile skin and joint hypermobility.

• Ejection systolic heart murmur - A heart murmur that occurs predominantly in midsystole, when ejection volume and velocity of blood flow are at their maximum; it is produced by ejection of blood into the pulmonary artery and aorta. It is typically crescendo-decrescendo.

• Electrocardiogram - A record of the electrical activity of the heart.

• Employment - The state of being engaged in an activity or service for wages or salary; the occupation for which you are paid.

• Endocrine system finding - Symptoms, physical examination results, and/or laboratory test results related to the endocrine system.

• Epistaxis - Bleeding from the nose.

• Erythrocyte sedimentation rate measurement - A quantitative measurement of the distance that red blood cells travel in one hour in a sample of unclotted blood.

• Evidence of previous streptococcal infection - The presence of a positive anti-Streptolysin-O or anti-DNase B, demonstrating that the patient was previously infected with Streptococcus.

• Examination of extremities - An assessment of the upper and lower extremities.

• Excessive daily caloric intake - The daily caloric intake is excessive.

• Excessive daily salt intake - The daily salt intake is excessive.

• Exercise - Activity that requires physical or mental exertion, especially when performed to develop or maintain fitness.

• Exercise cardiac stress test - A graded test to measure an individual's heart rate and oxygen intake while undergoing strenuous physical exercise; most often assessed on a treadmill.

• External genitalia examination - An assessment of the external genitalia.

• Extracardiac examination - A physical examination focusing on areas of interest other than the heart.

• Extraction of tooth - The surgical removal of a tooth from its bony socket.

• Faceplant - A syncopal event in which there is no attempt to protect oneself from the effects of the fall.

• Failure to thrive - A clinical finding indicating less than normal growth in an infant or child, or a state of global decline in an adult.

• Familial dysautonomia - A congenital disorder caused by mutations in the IKBKAP gene. It is characterized by damage of the sympathetic and parasympathetic and sensory nervous system.

• Family history of syncope - A history of a first-degree relative that has had syncope.

• Fatigue - Overall tiredness and lack of energy.

• Fecal incontinence - Involuntary passage of stool from the rectum.

• Feeding fatigue - A state of increased discomfort and decreased efficiency due to prolonged or excessive exertion during the taking of food.

• Femoral artery - An artery that starts within the inguinal region and extends to the lower extremities.

• Fetal alcohol syndrome - A teratogenic disorder observed in a newborn or child of a mother who consumed alcohol during pregnancy. Manifestations of the syndrome include low birth weight, atypical facies, microcephaly, failure to thrive, developmental defects, organ dysfunction, mental deficiencies, poor motor coordination and behavioral problems.

• Fever - Elevation of body temperature above normal due to inflammatory or immune responses.

• Fixed split s2 heart sound - An auscultated finding in which the semilunar valve closure sounds do not vary with respiration.

• Flushing - Reddening of the skin from a transient increase in blood flow.

• Forceful heartbeats - The sensation of an isolated cardiac contraction occurring with greater strength than that of a typical or normal contraction.

• Former smoker - A person who has quit smoking at the time of the interview but has smoked at least 100 cigarettes in their life.

• Frequency of chief complaint - The number of occurrences of the chief complaint over a given period of time.

• Frequency of routine caffeine intake - The frequency of caffeine consumed on a regular basis.

• Full time employment - Employed for a standard number of hours of working time, at least 50% or 20 hours per week.

• Fundoplication - A therapeutic surgical procedure to treat gastroesophageal reflux disease and hiatus hernia. It involves the wrapping of the fundus of the stomach around the lower esophagus to strengthen the lower esophageal sphincter.

• Gallbladder mucocele - The enlargement of the gallbladder secondary to prolonged obstruction of the cystic duct.

• Gangrene - Death of tissue, usually in considerable mass and generally associated with loss of vascular (nutritive) supply and followed by bacterial invasion and putrefaction.

• Gastrostomy - Creation of an opening between the stomach and the outside of the body.

• General appearance - The result of observation and overall assessment of a subject's outward aspect including appearance and movements; for example, in a human newborn general appearance includes skin color and tone, range of motion, and spontaneous movements.

• Genetic syndrome associated with congenital heart defect - Genetic anomalies and collections of malformations that are known to cluster together that can be associated with congenital heart defects.

• Genitalia examination - An assessment of the genitalia.

• Gestation - The period of fetal development in the uterus from the start of conception until its birth.

• Gestational complication - A difficulty or problem that occurs during intrauterine development that can jeopardize the health of the fetus.

• Glycogen storage disease - An inherited metabolic disorder characterized either by defects in glycogen synthesis or defects in the breaking down of glycogen. It results either in the creation of abnormal forms of glycogen or accumulation of glycogen in the tissues.

• Grade i heart sound - A heart sound that is very soft or intermittently heard.

• Grade ii heart sound - A heart sound that is as loud as the breath sounds.

• Grade iii heart sound - A heart sound that is louder than breath sounds.

• Grade iv heart sound - A heart sound that is louder than breath sounds in the presence of a palpated thrill.

• Grade school completion - Indicates that a person has attended grade school to completion. Depending on school system, this may indicate completion of sixth, seventh or eight grade.

• Grade v heart sound - A heart sound that can be auscultated with the stethoscope on a 45-degree angle or on its side in the presence of a palpated thrill.

• Grade vi heart sound - A heart sound that can be auscultated with the stethoscope off of the chest wall or with the naked ear.

• Graduate studies completion - Indicates that a person has completed a graduate studies program beyond a bachelor's degree.

• Hair brushing - The use of an implement with bristles to groom one's hair.

• Harsh heart murmur - A heart murmur that has an auditory quality in which the flow sounds highly turbulent.

• Has no sibling - An indication that an individual does not have a sibling.

• Has response to intervention for kawasaki disease - An indication that a patient responded to a treatment for Kawasaki disease.

• Has sibling - An indication that an individual has a sibling.

• Head and neck finding - Symptoms, physical examination results, and/or laboratory test results related to the head and neck.

• Headache - Pain in various parts of the head, not confined to the area of distribution of any nerve.

• Hear sound auscultation at left infraclavicular region - Heart sounds are auscultated on the precordial location corresponding to the anterior portion of the thorax directly below the left clavicle.

• Hear sound auscultation at right infraclavicular region - Heart sounds are auscultated on the precordial location corresponding to the anterior portion of the thorax directly below the right clavicle.

• Heart failure - Inability of the heart to pump blood at an adequate rate to meet tissue metabolic requirements. Clinical symptoms of heart failure include: unusual dyspnea on light exertion, recurrent dyspnea occurring in the supine position, fluid retention or rales, jugular venous distension, pulmonary edema on physical exam, or pulmonary edema on chest x-ray presumed to be cardiac dysfunction.

• Heart murmur - A periodic humming or blowing sound heard on auscultation of the heart that can indicate the presence of cardiac disease; murmurs are the result of vibrations caused by the turbulent flow of blood in the heart or great vessels. Murmurs are characterized according to the area of generation (mitral, aortic, tricuspid, or pulmonary) and according to the period of the cycle (systolic or diastolic).

• Heart murmur categorized by duration - The classification of a heart murmur based on its duration.

• Heart murmur categorized by phase or timing - The classification of a heart murmur based on the phase of the cardiac cycle or timing of its occurrence.

• Heart murmur categorized by quality - The classification of a heart murmur based on its characteristic quality.

• Heart rate - The number of heartbeats per unit of time, usually expressed as beats per minute.

• Heart sound - Auditory vibrations of varying intensity (loudness), frequency (pitch), quality, and duration noted during auscultation of the thorax as part of the examination of the cardiovascular system.

• Heart sound auscultation at apex - Heart sounds are auscultated on the precordial location corresponding to the blunt extremity of the heart formed by the left ventricle.

• Heart sound auscultation at back - Heart sounds are auscultated on the posterior portion of the trunk of the human body between the neck and the pelvis; the dorsum.

• Heart sound categorized by grade - The classification of a heart sound based on its intensity.

• Heart sound categorized by pitch - The classification of a heart sound based on its frequency.

• Heart valve repair - Surgery performed for the purpose of repairing a degenerated, calcified, malformed, dysfunctional, etc. heart valve.

• Heat sensation - An internal feeling of being warmer without a concomitant change in the ambient environment.

• Heavy smoker - A smoker who smokes more than 10 cigarettes per day, or an equivalent quantity of cigar or pipe smoke.

• Hematopoietic system finding - Symptoms, physical examination results, and/or laboratory test results related to the hematopoietic system.

• Hemoglobin measurement - A quantitative measurement of the amount of hemoglobin present in a sample.

• Hemoglobinopathy - An inherited disorder characterized by structural alterations of a globin chain within the hemoglobin molecule.

• Hemoptysis - Coughing up blood from the respiratory tract.

• Hepatomegaly - Abnormal enlargement of the liver.

• Herniorrhaphy - The surgical repair of a hernia by approximation of the intact tissues surrounding the defect.

• High frequency heart sound - A heart sound that can be auscultated only with the diaphragm of the stethoscope.

• High school completion - Indicates that a person has attended high school and has received a high school diploma.

• Hot bath or shower - Bathing or showering with water that has an extremely elevated temperature.

• Hot weather - Increased ambient temperature.

• Hyperactive chest appearance - Inspection of the region of the anterior surface of the chest and epigastrium reveals a highly or excessively active or hyperkinetic apical impulse.

• Hypercyanotic spell - A clinical finding in which a patient has profound cyanosis associated with hyperpnea; classically associated with tetralogy of Fallot.

• Hyperdynamic precordial palpation finding - A clinical finding in which palpation of the precordium reveals a hyperkinetic cardiac impulse with increased amplitude and forcefulness.

• Hyperpnea - A clinical finding in which there is deeper breathing than normal.

• Hyperventilation - Abnormally prolonged, rapid, and deep breathing.

• Hypotension - Blood pressure that is abnormally low.

• Hypotension due to cardiac dysfunction - A condition in which there is hypotension because of inadequate pumping function of the heart.

• Hypotension due to drug - A condition in which there is hypotension because of the effects of a medication or other substance.

• Hypoxemia - A finding indicating decreased oxygen levels in the blood.

• Illicit drug use history - A description of an individual's current and past use of illicit drugs.

• Inadequate daily caloric intake - The daily caloric intake is deficient.

• Inadequate daily fluid intake - The daily fluid intake is deficient.

• Inadequate daily salt intake - The daily salt intake is deficient.

• Increased emotional state - A state of mental excitement, characterized by physiological and behavioral changes.

• Individualized education plan - Indicates that a person has been educated through a Individualized education plan in primary and secondary school.

• Infective endocarditis prophylaxis - The use of antibiotics for the prevention of endocarditis.

• Infliximab given for kawasaki disease - An indication that infliximab was given as treatment for Kawasaki disease.

• Innocent murmur - A clinical finding in which turbulent flow is noted by auscultation that is not associated with any structural cardiac defects.

• Innocent pulmonary systolic murmur - An innocent murmur with a medium pitched, harsh character heard at the left middle and left upper sternal border that disappears with upright position.

• Inspiration - Taking ambient air into the lungs; breathing in.

• Integumentary system finding - Symptoms, physical examination results, and/or laboratory test results related to the integumentary system.

• Interventional cardiac catheterization - The performance of cardiac catheterization with the intent of making a modification to the structures of the heart or surrounding vessels.

• Irregular heart beat - A clinical finding in which the rhythm of the heart is noted to be abnormal.

• Isometric exercise - An exercise that is performed by exerting force against an immovable object or by holding an object in a static position.

• Ivig given for kawasaki disease - An indication that intravenously administered pooled immunoglobulins were given as treatment for Kawasaki disease.

• Kawasaki disease - A vasculitis characterized by inflammation of the arteries, particularly the coronary arteries. The vasculitis may lead to aneurysm formation and possibly, heart attacks. It affects young children who usually present with persistent high fever, redness of the mucous membranes of the mouth, redness of the palms and soles, skin rashes, lymphadenitis, and joint pain and swelling.

• Labile affect - Emotional instability characterized by rapid and dramatic mood swings.

• Ladd procedure - A surgical procedure performed to correct intestinal malrotation via division of the mesenteric (Ladd's) bands and detorsion of the affected segment(s) of the bowel. This procedure often includes appendectomy as the dissection of the bands often causes damage to the appendiceal vessels.

• Late diastolic heart murmur - A heart murmur that occurs during the last half of the ventricular filling phase. This may or may not extend to the first heart sound.

• Late systolic heart murmur - A heart murmur that occurs during the last half of the ventricular ejection phase. This may or may not extend to the second heart sound.

• Lethargy - Decreased consciousness characterized by mental and physical inertness.

• Leukocyte count - A test to determine the number of leukocytes in a sample of blood.

• Light smoker - A smoker who smokes less than 10 cigarettes per day, or an equivalent quantity of cigar or pipe smoke.

• Limb-girdle muscular dystrophy - A group of autosomal recessive and less frequently autosomal dominant muscular dystrophies affecting the muscles of the hips and shoulders.

• Lives alone - An indication that an individual lives alone.

• Living arrangement - A description of a personal residence and the relationship between the occupants that reside there.

• Location of chest pain - The anatomic location of one's chest pain.

• Location of heart sound auscultation - The location on the anterior chest wall where auscultation is undertaken.

• Location of patient evaluation prior to current chief complaint - The location of the prior clinical assessment of the patient for the current chief complaint.

• Location of point of maximum impulse - The location on the anterior chest wall where the point of maximum impulse is noted.

• Location of pulse measurement - The arterial location where palpation of a pulse is performed.

• Location of radiating chest pain - The anatomic location of where one's chest pain radiates.

• Loeys-dietz syndrome - A rare autosomal dominant syndrome caused by mutations in the TGFBR1 or TGFBR2 genes. It is characterized by vascular abnormalities including aortic and arterial aneurysms, aortic dissection, and tortuosity of the arteries. Other findings include scoliosis, long fingers, and joint hypermobility. Patients with TGFBR1 gene mutations also exhibit hypertelorism, bifid uvula, and early fusion of the skull bones.

• Long heart murmur - A heart murmur that occurs for an extended length of time after a valve closure sound.

• Loss of consciousness - An inability to purposefully respond to stimuli.

• Loud p2 heart sound - An auscultated finding in which the pulmonary valve closure sound is louder than normal.

• Loud s1 heart sound - An auscultated finding in which the sounds comprising the first heart sound are louder than normal.

• Low blood oxygen saturation - A low level of the degree to which oxygen is bound to hemoglobin given as a percentage calculated by dividing the maximum oxygen capacity into the actual oxygen content and multiplying by 100. Oxygen saturation usually is measured using pulse oximetry.

• Low frequency heart sound - A heart sound that can only be auscultated with the bell of the stethoscope.

• Lymphadenopathy - An enlarged lymph node. Causes include viral and bacterial infections and cancers that affect the lymph nodes.

• Machinery heart murmur - A heart murmur that has an auditory quality in which turbulence sounds similar to the workings of an industrial machine.

• Magnetic resonance imaging of the heart - Magnetic resonance imaging of the heart.

• Mammary souffle - An innocent murmur with a medium or high pitched, blowing character with continuous flow with systolic accentuation heard over or above the breasts that disappears with compression of the breast tissue.

• Marfan syndrome - A genetic syndrome inherited as an autosomal dominant trait. It is caused by mutations in the FBN1 gene. It is characterized by tall stature, elongated extremities, mitral valve prolapse, aortic dilatation, aortic dissection, and subluxation of the lens.

• Medication - A drug product that contains one or more active and/or inactive ingredients; it is intended to treat, prevent or alleviate the symptoms of disease. This term does not refer to the individual ingredients that make up the product.

• Medication for kawasaki disease - The medication(s) given to the patient for treatment of Kawasaki disease.

• Medication for rheumatic fever - The medication(s) given to the patient for treatment of rheumatic fever.

• Medication not taken - An indication that the patient has not taken medication.

• Medication taken - An indication that the patient has taken medication.

• Medium frequency heart sound - A heart sound that can be auscultated with both the diaphragm and the bell of the stethoscope.

• Medium heart murmur - A heart murmur that occurs for a medium length of time after a valve closure sound.

• Menstruation - The normal physiologic discharge through the vagina of blood and mucosal tissues from the nonpregnant uterus.

• Middiastolic heart murmur - A heart murmur that occurs during the middle portion of the ventricular filling phase.

• Midsystolic heart murmur - A heart murmur that occurs during the middle portion of the ventricular ejection phase.

• Minor criteria for rheumatic heart disease - The minor symptom criteria for rheumatic heart disease which include fever, arthralgia, elevated erythrocyte sedimentation rate (ESR), elevated C-reactive protein (CRP), elevated white blood cells (WBCs), and prolonged P-R interval.

• Minor criteria for rheumatic heart disease not present - An indication that the minor criteria for rheumatic heart disease are not present.

• Minor criteria for rheumatic heart disease present - An indication that the minor criteria for rheumatic heart disease are present.

• Movement - A change in location or position.

• Mucopolysaccharidosis - A group of autosomal recessive or X-linked inherited lysosomal storage disorders affecting the metabolism of mucopolysaccharides, resulting in the accumulation of mucopolysaccharides in the body. Signs and symptoms include organomegaly, intellectual disabilities, abnormal skeletal development, heart disorders, hearing loss, and central nervous system deficiencies.

• Multifrequency heart murmur - A heart murmur that has an auditory quality in which multiple frequencies are heard either simultaneously or in rapid succession.

• Multiple congenital anomalies - The presence of multiple congenital malformations in a patient.

• Multiple system atrophy - A rare neurodegenerative disorder characterized by loss of autonomic nervous system functions and disturbances of motor, balance and muscle coordination.

• Musculoskeletal finding - Symptoms, physical examination results, and/or laboratory rest results related to the muscles and bones.

• Myocardial infarction - Gross necrosis of the myocardium, as a result of interruption of the blood supply to the area, as in coronary thrombosis.

• Myopathy - A non-neoplastic disorder that affects the muscles. Representative examples include muscular dystrophy, metabolic myopathies, muscular atrophies, and dermatomyositis.

• Myopathy secondary to fatty acid oxidation disorder - A myopathy that was caused by a primary disorder of fatty acid oxidation.

• Myopathy secondary to glycogen storage disorder - A myopathy that was caused by a primary disorder of glycogen storage.

• Myotonic dystrophy - An inherited progressive disorder affecting the muscles. It is characterized by muscle wasting and hypotonia, cataracts, heart conduction defects and endocrinopathies.

• Myringotomy with ear tube placement - A surgical procedure where an incision is made through the eardrum, and a plastic or metal tube is inserted.

• Nausea - Upper abdominal discomfort associated with an urge to vomit.

• Neonatal complication - A difficulty or problem that occurs at or just after delivery of an infant that can jeopardize the health of the infant.

• Nervous system finding - Symptoms, physical examination results, and/or laboratory test results related to the nervous system.

• Neurogenic orthostatic hypotension - Orthostatic hypotension due to autonomic dysfunction. Primary neurogenic orthostatic hypotension (nOH) may be associated with disorders such as Parkinson disease (PD) and multiple system atrophy (MSA) whereas secondary nOH may be seen in peripheral neuropathies.

• Never smoker - A person who has never smoked at the time of the interview or has smoked less than 100 cigarettes in their life.

• Non-cardiac chest pain - Pain in the chest unrelated to a heart disorder.

• Nonspecific heart murmur - A heart murmur that has an auditory quality in which there are no recognizable characteristics to describe the turbulent sound.

• Nonsteroidal antiinflammatory drug - A pharmacological agent that is not a steroid and has potential anti-inflammatory, analgesic, antipyretic and anti-platelet activities. Most nonsteroidal anti-inflammatory drugs (NSAIDs) act by inhibiting the conversion of arachidonic acid to the precursors of prostaglandin and thromboxane by cyclooxygenase enzymes.

• Noonan syndrome - A genetic syndrome caused by mutations in the PTPN11 gene (over 50% of the cases) or less frequently mutations in the SOS1, RAF1, or KRAS genes. It is characterized by short stature, webbed neck, hypertelorism, low-set ears, deafness, and thrombocytopenia or abnormal platelet function.

• Normal abdomen on palpation - An indication that palpation of the abdomen demonstrates no organomegaly or masses found.

• Normal abdomen on visual inspection - An indication that there are no abnormal findings on visual inspection of the abdomen.

• Normal appearance of extremities - An indication that the extremities demonstrate no anomalies on visual inspection.

• Normal blood oxygen saturation - A measure of level of the degree to which oxygen is bound to hemoglobin is in the normal range.

• Normal capillary refill time - A clinical finding in which a capillary nail refill test returns to pink color in less than 2 seconds after pressure is removed.

• Normal chest appearance - Inspection of the region of the anterior surface of the chest and epigastrium reveals a normally shaped thorax, free from any infection, other form of disease or malformation or asymmetry; and a point of maximal impulse (apical impulse) that is a single outward impulse, usually located inside the mid clavicular point at the fifth intercostal space.

• Normal male external genitalia - An indication that on visual inspection the male external genitalia demonstrate no anomalies or abnormal findings.

• Normal point of maximum impulse - A clinical finding in which the point of maximum impulse is located in the midclavicular line, fifth intercostal space.

• Normal precordial palpation finding - A clinical finding in which palpation of the chest wall anterior to the heart reveals normal location and characteristic of the right ventricular and apical impulses without other palpable impulses.

• Normal skin - The pores are visible but not large. The skin texture is neither fine or thick and it neither feels dry or oily to the touch.

• Normal split s1 heart sound - An auscultated finding in which there is appropriate splitting between the closure sounds of the atrioventricular valve.

• Normal split s2 heart sound - An auscultated finding in which the semilunar valve closure sounds occur close together without occurring simultaneously and vary with respiration.

• Noxious stimulus - Hurtful, injurious, or pernicious action that produces a reaction in a receptor or tissue.

• Numbness - A loss of the sensation of feeling in an area of the body.

• Onset of chief complaint - The time period when the chief complaint first occurred.

• Opening snap - An auscultated finding describing a crisp, sharp sound that can be heard in the midprecordial location, caused by thickening and deformity of the atrioventricular valve.

• Orthostatic intolerance - A condition characterized by development of symptoms while standing. It is an autonomic nervous system disorder and the symptoms are relieved once the person sits back down. Symptoms include heart palpitations, sweating, anxiety, lightheadedness, hyperpnea, anxiety, and blurred vision.

• Osteogenesis imperfecta - A group of usually autosomal dominant inherited disorders characterized by defective synthesis of collagen type I resulting in defective collagen formation. It is characterized by brittle and easily fractured bones.

• Oxygen saturation measurement - The measurement of the ratio of oxygenated hemoglobin to total hemoglobin in the blood.

• Pain - The sensation of discomfort, distress, or agony, resulting from the stimulation of specialized nerve endings.

• Pain in epigastrium - The location of the pain is in the upper and middle region of the abdomen, located within the sternal angle.

• Palatorrhaphy - The surgical repair of a cleft palate by approximation of the intact tissues surrounding the defect.

• Pallid breath holding - A clinical condition in which there is a breath-holding spell associated with pale appearance.

• Pallor - An unusual or extreme paleness, state of decreased skin or mucosal coloration.

• Palpation - A method of feeling with the hands during a physical examination. The health care provider touches and feels the patient's body to examine the size, consistency, texture, location and tenderness of an organ or body part.

• Palpitation - An unpleasant sensation of irregular and/or forceful beating of the heart.

• Pansystolic heart murmur - A heart murmur that occurs during the entire systolic interval, from the first to second heart sounds.

• Part time employment - Employment involving less than the standard or customary working time.

• Pathologic murmur - A clinical finding in which turbulent flow is noted by auscultation that is associated with a structural cardiac defect.

• Pectus carinatum - A clinical finding in which there is protuberance of the sternum visible on examination of the chest.

• Pectus excavatum - A clinical finding in which there is depression of the sternum visible on examination of the chest.

• Pedal spasm - A spasmodic contraction of the muscles of the feet, especially the ankles, such as during alkalosis or tetany.

• Penicillin given for rheumatic fever - An indication that penicillin was given as treatment for rheumatic fever.

• Pericardial knock - An auscultated finding describing an early diastolic banging sound associated with pericardial constriction.

• Pericardial rub - An auscultated finding describing high or medium pitched and scratchy sound, generated by inflammation of the pericardial sac.

• Periodicity of chief complaint - The regular interval of time when the chief complaint recurs.

• Physical examination - A systemic evaluation of the body and its functions using visual inspection, palpation, percussion and auscultation. The purpose is to determine the presence or absence of physical signs of disease or abnormality for an individual's health assessment.

• Physiologic pulmonary artery stenosis murmur - An innocent murmur with a medium or high pitched, blowing character heard at the left middle sternal border that can also be heard at the same volume across the precordium and back that does not disappear with maneuvers but is only heard in infants less than six months of age.

• Platelet count - The determination of the number of platelets in a blood sample, usually expressed as platelets per cubic millimeter (cmm) of whole blood.

• Point of maximum impulse - A clinical finding demonstrating the pulsation associated with the contraction of the systemic ventricle. Typically associated with the apex of the heart.

• Polyarticular arthritis - An arthritis affecting five or more separate joints.

• Poor feeding - Occurs either when an infant shows no interest in feeding or when there is an inability to take in adequate nutrition. Poor feeding is a nonspecific symptom of many disorders, including neurological, genetic, structural, metabolic, and infectious diseases.

• Poorly perfused - A clinical condition in which there is insufficient blood flow to the core or to the extremities.

• Post term birth - Birth at greater than or equal to 42 weeks and 0 days.

• Posterior tibial artery - A terminal branch of the popliteal artery that runs along the tibia from the lower portion of the popliteus muscle to the lower ankle with numerous branches supplying the lower leg and foot.

• Postictal confusion - A period of confusion following a seizure in which the patient does not respond appropriately despite appearing awake.

• Postural orthostatic tachycardia syndrome - A syndrome characterized by orthostatic intolerance resulting in tachycardia, often accompanied by a decrease in the blood pressure. It occurs when individuals change from the supine position to an upright position. Other signs and symptoms include lightheadedness, fainting, fatigue and muscle weakness.

• Precordial catch syndrome - A condition in which there is musculoskeletal chest pain characterized by brief, sharp discomfort associated with inspiration.

• Precordial palpation - Palpation of the part of the chest wall that is located anterior to the heart.

• Precordial palpation finding of lift or heave - A clinical finding in which there is an abnormally increased and sustained systolic pulsation found on palpation of the chest wall over the heart, including over a ventricle or the pulmonary artery area. This is typically associated with increased blood volume or pressure in the associated chamber.

• Precordial palpation finding of palpable heart sound - A clinical finding in which a heart sound is felt during palpation of the chest wall.

• Precordial palpation finding of tap - A clinical finding in which there is an abnormally increased and localized brief pulsation found on palpation of the chest wall over the heart, typically associated with ventricular hypertrophy or increased intraventricular pressure.

• Precordial palpation finding of thrill - A clinical finding in which humming vibration; accompanying a loud, harsh or rumbling murmur felt during palpation of the precordium or over the blood vessels.

• Presenting finding of congenital heart disease - The presenting findings of congenital heart disease in the patient.

• Pressure - The force applied to a unit area of surface.

• Pressure chest pain - The sensation of chest pain described as an object creating physical force.

• Preterm birth - Birth when a fetus is less than 37 weeks and 0 days gestational age.

• Primary pulmonary hypertension - Pulmonary hypertension that is not caused by any other disease or condition.

• Prior patient evaluation for current chief complaint - A prior clinical assessment of the patient for the current chief complaint.

• Prolonged standing - The state of being in an upright position continuing for a time greater than what would be considered normal.

• Protuberant abdomen - An indication that there is unusual or prominent convexity of the abdomen on visual inspection.

• Psychiatric finding - Symptoms, physical examination results, and/or laboratory test results related to mental health.

• Psychogenic musculoskeletal chest pain - A condition in which there is the sensation of musculoskeletal chest pain due to a conversion disorder.

• Psychogenic syncope - A condition in which syncope occurs due to a conversion disorder.

• Pulmonary hypertension - Increased pressure within the pulmonary circulation due to lung or heart disorder.

• Pulse wave absent - A clinical finding in which palpation of a pulse demonstrates no upstroke or amplitude.

• Pulse wave amplitude measurement - The measurement a pulse wave's amplitude by palpation.

• Pulse wave decreased - A clinical finding in which palpation of a pulse demonstrates a diminished upstroke and/or amplitude.

• Pulse wave increased - A clinical finding in which palpation of the pulse demonstrates a significantly increased upstroke and/or amplitude.

• Pulse wave markedly increased - A clinical finding in which palpation of the pulse demonstrates a significantly increased upstroke, amplitude, and rapid decay.

• Pulse wave normal - A clinical finding in which palpation of the pulse demonstrates appropriate upstroke, amplitude, and decay.

• Quality of chest pain - The characteristics of chest pain as described by the patient.

• Quality of palpitations - The characteristics of the palpitations as described by the patient.

• Racing heartbeats - The sensation of an abnormally rapid heart rate. (AHA/CC)

• Radial artery - The branch of the brachial artery that passes down the forearm.

• Radial-femoral lag - A delay between the upstroke of the right radial pulse and a femoral pulse who presence indicates coarctation of the aorta.

• Radial-femoral lag absent - An indication that a radial-femoral lag is not present.

• Radial-femoral lag present - An indication that a radial-femoral lag is present.

• Recurrent disease - The return of a disease after a period of remission.

• Relapse following intervention for kawasaki disease - An indication that there was a relapse following treatment for Kawasaki disease.

• Resolution of findings following intervention for kawasaki disease - An indication that findings were resolved following treatment for Kawasaki disease.

• Respiratory distress - A pathological increase in the effort and frequency of breathing movements.

• Respiratory rate - The rate of breathing (inhalation and exhalation) measured within in a unit time, usually expressed as breaths per minute.

• Respiratory system finding - Symptoms, physical examination results, and/or laboratory test results related to the respiratory system.

• Response to intervention for kawasaki disease - The patient's response to treatment of Kawasaki disease.

• Resting - Freedom from activity.

• Retreatment following intervention for kawasaki disease - An indication that retreatment was required following initial treatment for Kawasaki disease.

• Reverse split s1 heart sound - An auscultated finding in which the tricuspid valve closure sound occurs before the mitral closure sound.

• Reverse split s2 heart sound - An auscultated finding in which the pulmonic valve closure sound occurs prior to the aortic valve closure sound.

• Review of systems - A comprehensive assessment of a patient, which includes a subjective history taking component as well as an objective based structured interview and physical examination of all the body systems.

• Rheumatic fever - An inflammatory disorder that follows infection with group A streptococcus. It affects the heart, joints, and subcutaneous tissues. It manifests with pericarditis, heart murmur, congestive heart failure, polyarthritis, subcutaneous nodules, and erythema marginatum. It is characterized by the formation of granulomatous lesions called Aschoff bodies usually in the heart tissue.

• Rheumatic fever symptom - The symptoms of rheumatic fever that the patient had.

• Rheumatic fever symptom onset age - The age of the patient when the symptoms of rheumatic fever were first noted.

• Rheumatic fever symptom onset date - The date of the first onset of the symptoms of rheumatic fever.

• Rheumatological finding - Symptoms, physical examination results, and/or laboratory test results related to diseases and disorders of the connective tissues.

• Right arm blood pressure measurement - The arterial blood pressure as measured from the right arm.

• S1 heart sound - An auscultated finding describing the heart sound that occurs with ventricular systole and is produced mainly by closure of the atrioventricular valves, signifying the first heart sound.

• S1 heart sound type - The type of S1 heart sound that is auscultated.

• S2 heart sound - An auscultated finding describing the heart sound that signifies the beginning of diastole and is caused by closure of the semilunar valves, signifying the second heart sound.

• S2 heart sound type - The type of S2 heart sound that is auscultated.

• S3 gallop - A finding which can be heard on auscultation of the heart in the setting of congestive heart failure. The sound of the S3 gallop, which immediately follows the second heart sound (S2) is thought to be produced by the sound of blood flowing into a noncompliant ventricle.

• S4 heart sound - An auscultated finding that describes a low-frequency sound, heard late in diastole just before S1, caused by forceful atrial contractions, signifying the fourth heart sound. It is typically abnormal, except in highly trained athletes and the elderly.

• Scaphoid abdomen - An indication that the anterior abdominal wall is sunken or has a concave appearance on visual inspection.

• Secondary pulmonary hypertension - Pulmonary hypertension that is caused by an underlying condition.

• Seizure - Sudden, involuntary skeletal muscular contractions of cerebral or brain stem origin.

• Sequelae of intervention for kawasaki disease - The sequelae of treatment given for Kawasaki disease.

• Severity of chief complaint - The intensity of the chief complaint perceived by the patient.

• Sharp chest pain - The sensation of chest pain described as a stabbing feeling.

• Short heart murmur - A heart murmur that occurs for a brief length of time after a valve closure sound.

• Sibling - A person's brother or sister.

• Signs and symptoms associated with chief complaint - The signs and symptoms present with the chief complaint.

• Simple breath holding - A clinical condition in which there is a breath-holding spell without syncope.

• Single s1 heart sound - An auscultated finding in which the atrioventricular valve closure sounds occur so close together as to sound single.

• Single s2 heart sound - An auscultated finding in which the semilunar valve closure sounds occur simultaneously.

• Situational syncope - A condition in which neurally-mediated syncope occurs due to a specific circumstance, such as micturition, defecation, coughing, or traction of the hair.

• Skin examination - An assessment of the skin via physical examination.

• Skin rash - Any change in the skin which affects its appearance or texture. A rash may be localized to one part of the body, or affect all the skin. Rashes may cause the skin to change color, itch, become warm, bumpy, dry, cracked or blistered, swell and may be painful.

• Skipped heartbeats - The sensation of an isolated cardiac contraction occurring prior to the normal or regular rhythm.

• Sleep disorder - A change from the patient's baseline sleeping pattern, in the hours slept and/or an alteration/dysfunction in the stages of sleep.

• Smoker, current status unknown - Indicates a person who is known to have smoked but whose current smoking status is unknown.

• Social history - Past events that occurred between individuals and/or their communities.

• Soft s1 heart sound - An auscultated finding in which the sounds comprising the first heart sound are quieter than normal.

• Spinal fusion - Fusing two or more vertebrae into one.

• Splenomegaly - Abnormal enlargement of the spleen.

• Squeaky heart murmur - A heart murmur that has an auditory quality in which the turbulence is brief and noted with the diaphragm of the stethoscope only.

• Stable angina - Angina pectoris which has not recently changed in frequency, duration or intensity. Stable angina pectoris is relieved by rest or administration or oral, sublingual or transdermal antianginal medications.

• Startle - A quick involuntary movement in response to an alarm, surprise, or fright.

• Stature - The height of a person while standing.

• Sterile pyuria - The presence of leukocytes in the urine without evidence of an infection.

• Sternotomy scar - Replacement of destroyed tissue by fibrous tissue due to a surgical procedure where a vertical inline incision is made along the sternum, after which the sternum itself is divided.

• Steroids given for rheumatic fever - An indication that steroids were given as treatment for rheumatic fever.

• Still's murmur - An innocent murmur with a medium pitched, vibratory character heard at the apex, left lower sternal border, left middle sternal border, and right upper sternal border that disappears or becomes quieter and localizes to the left lower sternal border on upright position.

• Stooping - The act of bending one's back forward from the waist on down.

• Strawberry tongue - A pathological finding in which inflammation, hyperemia and enlarged papillae of the dorsum of the tongue resemble a strawberry. It may be seen in variety of bacterial and viral disorders, and in non-infectious disorders such as Kawasaki disease.

• Stretching - A physical exercise in which a specific muscle or tendon is deliberately flexed or stretched in order to improve the muscle's elasticity.

• Stridor - A symptom resulting from laryngeal obstruction. It is characterized by a high pitched breathing sound.

• Subcutaneous nodule - A small palpable mass in the subcutaneous tissues.

• Summation gallop - An auscultated finding in which S3 and S4 fuse, during tachycardia or a prolonged PR interval or both.

• Supine position - A posterior recumbent body position whereby the person lies on its back and faces upward.

• Surgery for rheumatic fever - A surgical procedure performed as part of the treatment for the sequelae of rheumatic fever.

• Swimming - The act of propelling the body through water by movement of the arms and/or legs.

• Sydenham chorea - A neurologic disorder characterized by smooth involuntary, uncoordinated movements affecting especially the hands, feet, and face.

• Symmetric chest appearance - Inspection of the region of the anterior surface of the chest and epigastrium reveals an approximate correspondence of form and constituent configuration on opposite sides of a vertical central dividing line.

• Symptomatic presentation - A clinical description in which a patient demonstrates evidence of more than one clinical finding suggestive of underlying pathology.

• Syncope - A spontaneous loss of consciousness caused by insufficient blood supply to the brain.

• Syncope due to acquired heart lesion - A condition in which syncope occurs due to a disease process of the heart with which the patient was not born.

• Syncope due to congenital heart lesion - A condition in which syncope occurs due to a disease process of the heart with which the patient was born.

• Syncope due to migraine - A condition in which syncope occurs associated with the occurrence of cerebral vasospasm.

• Syncope due to pulmonary hypertension - A condition in which syncope occurs associated with a sudden and severe increase in pulmonary vascular resistance.

• Syncope with exertion - A condition in which syncope occurs either during or after physical activity.

• Systolic click - An auscultated finding describing a sharp, high-frequency sound heard during auscultation of the thorax caused by valvular prolapse or stenosis.

• Systolic heart murmur - A heart murmur that occurs during ventricular ejection, while the semilunar valves are open.

• Systolic whoop - An auscultated finding describing a loud musical or sonorous vibratory systolic murmur that may be heard in patients with atrioventricular valve prolapse.

• Systolic-diastolic heart murmur - An accentuated heart murmur that occurs during both ventricular ejection and ventricular filling phases.

• Tachypnea - Abnormal increase of rate of breathing.

• Tearing chest pain - The sensation of chest pain described as a sharp, lacerating, intense, discomfort; sometimes used to describe the pain felt during an aortic dissection.

• Term birth - Birth at greater than or equal to 37 weeks using best estimated due date.

• Tests performed at patient evaluation prior to current chief complaint - The studies performed during the prior clinical assessment of the patient for the current chief complaint.

• Thoracotomy scar - Replacement of destroyed tissue by fibrous tissue due to a surgical procedure where an incision was made into the chest wall to the left or to the right of the midline.

• Tingling - A sensation as of repetitive pin pricks, caused by cold or by striking a nerve, or as a result of various diseases of the central or peripheral nervous system.

• Tobacco smoking history - A record of an individual's background in regard to smoking tobacco. This would include such factors as start date, end date (if applicable), number of cigarette smoked, attempts to quit, and others.

• Tongue biting - Clamping of the teeth on the tongue, as can accompany a seizure.

• Tonsillectomy - Surgical removal of the tonsils.

• Trisomy 13 - A chromosomal abnormality characterized by the presence of three copies of genetic material for chromosome 13, instead of the normal two. It leads to a variety of abnormalities that include mental retardation, microcephaly, low-set ears, eye structural defects, polydactyly, and limb abnormalities.

• Trisomy 18 - A chromosomal abnormality consisting of the presence of a third copy of chromosome 18 in somatic cells.

• Trisomy 21 - A chromosomal abnormality consisting of the presence of a third copy of chromosome 21 in somatic cells.

• Tuberous sclerosis - Hereditary disease characterized by seizures, mental retardation, developmental delay, and skin and ocular lesions. First signs usually occur during infancy or childhood but in rare cases may not occur until 2nd or 3rd decade.

• Turner syndrome - A gonadal dysgenesis syndrome occurring in phenotypic females, characterized by the absence of a part or all of one of the sex chromosomes. Signs and symptoms include short stature, webbing of neck, low-set ears, hypogonadism, and sterility.

• Type of response to intervention for kawasaki disease - The type of response noted after treatment was given for Kawasaki disease.

• Ulnar artery - A terminal branch of the brachial artery arising just below the elbow that runs along the ulna into the wrist with numerous branches supplying the forearm, wrist and hand.

• Unemployment - The state of not having a job.

• Unstable angina - Angina pectoris (or equivalent type of ischemic discomfort) which has recently changed in frequency, duration, intensity, or occurs at rest.

• Urinary incontinence - Involuntary passage of urine outside the body.

• Urination - The discharge of urine.

• Vacterl association - An association of congenital birth defects that includes vertebral abnormalities, anal atresia, cardiac abnormalities, tracheo-esophageal fistula, renal abnormalities, and limb abnormalities.

• Valve replacement - Surgery performed with the purpose of replacing a degenerated, calcified, malformed, dysfunctional, etc. cardiac valve with a bioprosthetic, homograft, or autograft valve.

• Variant angina - A variant form of angina pectoris caused by coronary artery vasospasm, usually occurring spontaneously and frequently associated with ST segment elevation.

• Vasodepressor syncope - A condition in which neurally-mediated syncope occurs in which the blood pressure falls and the heart rate increases.

• Vasovagal syncope - An autonomic reflex response to emotional or orthostatic stress, which is characterized by paradoxical hypotension and bradycardia.

• Venous hum - An innocent murmur with a medium pitched, blowing character with diastolic accentuation heard at the right or left upper sternal border that disappears with jugular venous compression or supine position.

• Ventriculoperitoneal shunt placement - A therapeutic procedure that involves the placement of a tube in one of the ventricles of the brain to allow for drainage of cerebrospinal fluid (CSF) into the peritoneal cavity. It is used to relieve hydrocephalus.

• Vibratory heart murmur - A heart murmur that has an auditory quality with a distinct groaning, croaking, buzzing or twanging.

• Vital signs measurement - The act of assessing an individual's current temperature, heart rate, respiratory rate, pulse oxygenation, and blood pressure.

• Well perfused - A clinical finding in which there is sufficient blood flow to the core and extremities.

• Wheezing - A symptom and a finding during physical examination, characterized by a high-pitched, whistling sound during breathing. It results from the narrowing or obstruction of the respiratory airways. The most common causes of wheezing are asthma, chronic obstructive pulmonary disease, tracheobronchitis, and pulmonary edema.

• Widely split s2 heart sound - An auscultated finding in which the semilunar valve closure sounds occur further apart in time than normal.

• Widened s1 heart sound - An auscultated finding in which the mitral and tricuspid closure sounds are wider apart in time than normal.

• Williams syndrome - A rare syndrome caused by multiple gene deletions from a region of chromosome 7, including the deletion of CLIP2, ELN, GTF2I, GTF2IRD1 and LIMK1 genes. It is characterized by distinctive facial appearance (elfin facies), mild-to-moderate mental retardation, cheerfulness, cardiovascular abnormalities and infantile hypercalcemia.