Physical Signs (information Overview)

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PHYSICAL SIGNS Download a copy of this study guide Sign

Description, Finding

Doll's Eye Sign

Dissociation between movement of the eyes and of the head. Eyes moves up and head moves down.

Babinski's Sign

Fanning of big toe when you stroke the plantar aspect of the foot

CNS: Pyramidal Tract Lesion

Chaddock's Sign

Great toe fanning when you touch the external malleolar skin

CNS: Corticospinal tract lesions

Eyelash Sign

Stroking eyelash produces no movement of lids.

CNS: Organic stroke.

Stroking eyelash produces movement of lids.

CNS: Functional hysteria

Hoffman's Sign

Indication

Nipping nail of middle finger cause flexion of terminal CNS: Pyramidal Tract phalanx of thumb. Unilaterally. Disease

Digital Reflex Clenched Fist (Levine's) Sign

Holding clenched fist over chest to describe constricting, pressing pain

CV: Angina Pectoris

de Musset's Sign

Rhythmic jerking movement of the head

CV: Aortic Insufficiency

Ewart's Sign

Dullness, bronchial breathing, bronchophony over the angle of the left scapula.

CV: Pericardial effusion

Hamman's Sign

Crunching sound synchronous with heartbeat.

CV: Mediastinal Emphysema, Pneumopericardium

Hill's Sign

Exaggerated femoral artery systolic pressure (60 to 100 mm Hg higher) over brachial systolic pressure.

CV: Aortic Insufficiency

Homan's Sign

Pain in back of calf or knee when foot is dorsiflexed.

CV: Thrombosis in veins of calf

Kussmaul's Sign

Paradoxical increase in jugular venous distension when patient inspires.

CV: Cardiac Tamponade

Osler's Sign

Painful erythematous swellings in skin and subcutaneous tissues of hands and feet.

CV: Endocarditis

Joffroy's Sign

No forehead wrinkling when the eyeballs are rolled upward.

Endocrine: Grave's Disease

Möbius Sign

Impaired ocular convergence (accommodation)

Endocrine: Grave's Disease

Stellwag's Sign

Infrequent and incomplete blinking.

Endocrine: Grave's Disease

Kestenbaum's Sign

Decrease in number of arterioles crossing optic disk margins.

Eye: Optic Atrophy

Marcus Gunn Pupillary Sign

Flashlight swung from one eye to the other eye, then both pupils dilate (when they should constrict).

Eye: Cataract, optic nerve defects

Cullen's Sign

Periumbilical darkening of the skin

GI: Intraperitoneal hemorrhage, from hemorrhagic pancreatitis or ectopic pregnancy

Grey Turner's Sign

Local discoloration of the skin of the loins

GI: Acute hemorrhagic pancreatitis

Groove Sign

Firm nodes in groin above and below inguinal ligament, with a groove along the ligament.

GI: Lymphogranuloma Venereum

Kehr's Sign

Violent pain in the left shoulder

GI: Ruptured Spleen

Puddle Sign

Patient gets on all fours, and palpating at one end allows auscultation at the other end of the abdomen.

GI: Ascites

Stethoscope moves from most dependent position gradually contralaterally. Rovsing's Sign

Pain in right abdomen at McBurney's Point when pressure is exerted on left abdomen.

GI: Appendicitis

Bárány's Sign

Irrigate ear with cold water: should lead to nystagmus on opposite side.

Head and Neck: Labyrinthine disease, such as Meniere's Disease

Irrigate ear with warm water: should lead to nystagmus on same side. This sign shows no nystagmus Battle's Sign

Postauricular ecchymosis

Head and Neck: fracture of the base of the of the skull.

Brudzinski's Sign

(1) Contralateral leg reflex: passive flexion of leg on one side elicits reflex on the opposite side.

Infectious: Meningitis

(2) Passively flex neck, and hips and knees flex spontaneously. Kernig's Sign

Patient lies on back and flexes thigh upward, then complete extension of leg is impossible.

Infectious: Meningitis

Pastia's Sign

Hemorrhagic transverse lines at bend of elbow, wrist, or inguinal region. It persists after desquamation.

Infectious: Scarlet Fever

Romberg's Sign

Close eyes and lose gait; ataxia.

Infectious: Tabes Dorsalis

Winterbottom's Sign

Swelling of posterior cervical lymph nodes.

Infectious: African Sleeping Sickness (Trypanosomiasis)

Chvostek's Sign

Facial irritability. Unilateral spasm induced by tap over the facial nerve.

Muscular: Tetany

Trousseau's Sign

Upper arm compressed by a tourniquet or bloodpressure cuff causes carpal spasm.

Muscular: Tetany

Braxton Hicks Contractions

Irregular uterine contractions after third month of pregnancy.

OB/GYN: Pregnancy

Chadwick's Sign

Bluish discoloration of cervix and vagina

OB/GYN: Pregnancy

Drawer Sign

Forward sliding (anterior cruciate) or backward sliding Skeletal: Disruption of (posterior cruciate) of the tibia. anterior (forward slide) or posterior (backward slide) cruciate ligaments of knee.

Lasègue's Sign

When patient is supine with hip flexed up, dorsiflexion of the ankle causes pain.

Skeletal: Sciatic Nerve irritation (Sciatica)

Nikolsky's Sign

Sliding pressure of thumb pressed against skin separates outer layer from basal dermis.

Skin: Pemphis Vulgaris

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SYNDROMES Download a copy of this study guide Organized by Category: • • • • • • • • • • •

Environmental Causes Cardiovascular Iatrogenic Neoplastic Congenital Endocrine Pulmonary Infectious Renal Neurological Gastrointestinal

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Reticulo-endothelial, Hematologic Uncategorized

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ENVIRONMENTAL CAUSES •

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ACUTE RADIATION SYNDROME: Radiation exposure. o 12 hours post-exposure: Vomiting o 24 hours post-exposure: Prostration (extreme exhaustion), fever, diarrhea o Later: Petechial hemorrhage, hypotension, tachycardia, profuse bloody diarrhea, maybe death. CHINESE RESTAURANT SYNDROME: MSG reaction ------> Chest Pain, burning sensation over parts of body. BROWN-SEQUARD SYNDROME: Damage (injury) to half of spinal cord ------> symptoms: o Loss of pain and temperature sensation on contralateral side of body. o Loss of proprioception and discriminatory touch on ipsilateral side of body.

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CARDIOVASCULAR • • • • •

ADAMS-STOKES SYNDROME: Heart block, with slow or absent pulse, often accompanied by convulsions. BARLOW SYNDROME: Floppy Mitral Valve Syndrome; Massive Mitral Valve Prolapse ------> Late apical systolic murmur, systolic click, or both. EISENMENGER'S SYNDROME: Ventricular-Septal Defect ------> Pulmonary hypertension and cyanosis. FLOPPY-VALVE SYNDROME: Mitral Incompetence due to myxomatous degeneration of the leaflets. LERICHE'S SYNDROME: Occlusion of distal aorta ------> o Hip, thigh, and calf fatigue. o Impotence

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BEHCET'S SYNDROME: Vasculitis ------> secondary symptoms: o Oral and genital ulcers o Uveitis o Optic atrophy SHOULDER-HAND SYNDROME: Pain in shoulder and swelling in hand, sometimes occurring after Myocardial Infarction. SICK SINUS SYNDROME: Chaotic atrial activity; continual changes in P-Waves. Bradycardia, alternating with recurrent ectopic beats and runs of tachycardia. SUPERIOR VENA CAVA SYNDROME: Caused by a tumor. Obstruction of SVC ------> o Edema o Engorgement of the vessels of face, neck, and arms. o Nonproductive cough o Dyspnea TAKAYASU'S SYNDROME: Arteritis of the Aortic Arch, resulting in no pulse. Seen in young women. WOLF-PARKINSON WHITE SYNDROME: ECG pattern of Paroxysmal Tachycardia. o Short PR interval o Delta wave = early QRS complex.

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IATROGENIC (or Secondary to Medical Treatment) • •

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AFFERENT LOOP SYNDROME: Gastrojejunal loop obstruction, proximal to a gastrojejunostomy. o Ingestion of food produces nausea, pain, and duodenal distension. ASHERMAN'S SYNDROME: Adhesions within the endometrial cavity, causing amenorrhea and infertility. o Adhesions probably were caused by surgery. ULYSSES SYNDROME: Ill effects from follow-up diagnostic tests following a false-positive screening test.

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NEOPLASTIC (Malignant or Benign) •

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CARCINOID SYNDROME: Carcinoid tumor producing Bradykinin + Serotonin ------> secondary symptoms: o Cyanotic flushing o Diarrhea o Bronchial spasm o Edema, ascites. CRONKHITE-CANADA SYNDROME: GI-Polyps with diffuse alopecia (hair-loss) and nail dystrophy. o May see protein-losing enteropathy and malabsorption. GARDNER'S SYNDROME: Multiple inherited tumors, hereditary dominant trait. o Skull osteomas, Fibromas, Epidermoid cysts o Colonic polyposis (APC gene) ------> predisposition to colonic adenocarcinoma. LAMBERT-EATON SYNDROME: Progressive proximal muscle weakness secondary to a carcinoma. MEIGS' SYNDROME: Fibroma of ovary with ascites and hydrothorax PANCOAST SYNDROME: Tumor near pulmonary apex ------> o Neuritic pain of chest and arm o Muscle atrophy of the arm o Horner's Syndrome (impaired cervical sympathetics) PEUTZ-JEGHERS SYNDROME: Polyposis (hamartomas) of small intestine o Also see melanin pigmentation of buccal mucosa and skin around mouth and lips

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CONGENITAL • • • •

CEREBELLAR SYNDROME: Congenital Cerebellar Ataxia CERVICAL SYNDROME: Supernumerary C7 rib ------> Pressure on brachial plexus ------> pain radiating over shoulder, arm, and forearm over C7 distribution. DANDY-WALKER SYNDROME: Obstruction of Foramina of Magendie and Luschka in infants -----> Hydrocephalus. DIGEORGE SYNDROME: Congenital absence of 3rd and 4th Branchial Arches (Thymus and Parathyroid Glands) ------> secondary symptoms: o No cell-mediated immunity ------> Frequent viral and fungal infections

Characteristic facial deformities DOWN SYNDROME: Trisomy 21. Mental retardation, characteristic facial features, Simeon crease in hand. FANCONI'S SYNDROME Type I: Bone-marrow hypoplasia ------> refractory anemia, pancytopenia. EHLERS-DANLOS SYNDROME: Congenital defect in collagen. o Hyper-elasticity and friability of the skin. o Hyperextensibility of the joints. FETAL ALCOHOL SYNDROME: Fetal malformations, growth deficiencies, craniofacial anomalies, limb defects. GOODPASTURE'S SYNDROME: Autoantibodies against basement membranes ------> Glomerulonephritis (kidney) and hemoptysis (lungs). o Often, death by renal failure KLINEFELTER'S SYNDROME: Trisomy XXY ------> testicular atrophy, increase in gonadotropins in urine. KLIPPEL-FEIL SYNDROME: o Cervical vertebrate fused o Congenital short neck, limited neck rotation o Abnormalities of the brainstem and cerebellum o Low hairline. LESCH-NYHAN SYNDROME: Deficiency of HGPRT (Hypoxanthine-Guanine Phosphoribosyltransferase ------> o Hyperuricemia, uric acid kidney stones o Choreoathetosis o Mental retardation, autism, spastic cerebral palsy o X-Linked recessive MARFAN SYNDROME: Connective Tissue disorder ------> o Arachnodactyly: Abnormally long digits and extremities o Subluxation of lens o Dissecting aortic aneurism POSTRUBELLA SYNDROME: Infantile defects resulting from maternal Rubella infection during first trimester. o Microphthalmos, cataracts o Deafness o Mental retardation o Patent ductus arteriosis, Pulmonary arterial stenosis PRADER-WILLI SYNDROME: Short stature, mental retardation, polyphagia with marked obesity, sexual infantilism. o

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RENDU-OSLER-WEBER SYNDROME: Hereditary hemorrhagic telangiectasia. SUDDEN INFANT DEATH SYNDROME: Unexplained death in sleeping infants. TURNER'S SYNDROME: XO monosomy. o Dwarfism o Webbed neck o Valgus of elbow. o Amenorrhea WILSON SYNDROME: Congenital defect in Ceruloplasmin, leading to buildup of copper ------> mental retardation, cirrhosis, hepatolenticular degeneration.

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ENDOCRINE, REPRODUCTIVE • • •

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AMENNORRHEA-GALACTORRHEA SYNDROME: Non-physiologic lactation, resulting from endocrinologic causes or from a pituitary disorder. CONN'S SYNDROME: Primary Hyperaldosteronism ------> muscular weakness, hypertension, hypokalemia, alkalosis. CUSHING'S SYNDROME: Hypersecretion of cortisol ------> secondary symptoms and characteristics: o Fatness of face and trunk with wasting of extremities o Buffalo hump o Bone decalacification o Corticoid diabetes o Hypertension PREMENSTRUAL SYNDROME: Abnormal sensation in breasts, abdominal pain, thirst, headache, pelvic congestion, nervous irritability. o Ocassionally nausea and vomiting. SHEEHAN'S SYNDROME: Post-partum pituitary necrosis ------> hypopituitarism. STEIN-LEVENTHAL SYNDROME: Polycystic ovary ------> infertility, amenorrhea, hirsutism. Seen in obese women. TESTICULAR FEMINIZATION SYNDROME: Insensitivity to Testosterone. Male Psuedohermaphroditism o Complete female external genatalia, incompletely developed vagina, rudimentary uterus.

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PULMONARY • • • •

KARTAGENER'S SYNDROME: Situs Inversus (lateral transposition of lungs) resulting from chronic sinusitis and bronchiectasis. HAMMAN-RICH SYNDROME: Interstitial fibrosis of the lung. MIDDLE-LOBE SYNDROME: Chronic pneumonitis and atalectasis of middle lobe of right lung. CHURG-STRAUSS SYNDROME: Allergic Granulomatous Angiitis: Asthma, fever, eosinophilia.

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INFECTIOUS • • •

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FITZ-HUGH-CURTIS SYNDROME: Gonococcal Periphepatitis in woman, as a complication of Gonorrhea. GUILLAN-BARRE SYNDROME: Infectious Polyneuritis of unknown cause. HUNT'S SYNDROME: Herpe's Zoster infection of Facial Nerve (CN VII) and Geniculate Ganglion ------> facial palsy. o Zoster of ear REYE'S SYNDROME: Loss of consciousness and seizures in kids, after a viral infection treated by aspirin. REITER'S SYNDROME: Symptom cluster. Etiology is thought to be Chlamydial or post-chlamydial. o Urethritis o Iridocyclitis (Conjunctivitis) o Arthritis o Skin lesions like karatoderma blenorrhagicum o Also can see fatty liver or liver necrosis. SCALDED SKIN SYNDROME: S. Aureus toxic epidermal necrolysis. STEVENS-JOHNSON SYNDROME: Erythema Multiforme complication. o Large areas of skin slough, including mouth and anogenital membranes. o Mucous membranes: stomatitis, urethritis, conjunctivitis. o Headache, fever, malaise.

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TOXIC SHOCK SYNDROME: Caused by superabsorbent tampons. Infection with Staph Aureus and subsequent toxicity of exotoxin TSST ------> systemic anaphylaxis. o Fever, vomiting, diarrhea o Red rash followed by desquamation WATERHOUSE-FRIEDRICHSON SYNDROME: Meningeococcal Meningitis ------> DIC, hemorrhagic infarct of adrenal glands ------> fulminant adrenal failure. o Vomiting, diarrhea. o Shock o Extensive purpura, cyanosis, circulatory collapse.

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RENAL • •

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KEMMELSTIEL-WILSON SYNDROME: Diabetic Glomerulosclerosis. BARTTER'S SYNDROME: Juxtaglomerular Cell Hyperplasia ------> secondary symptoms: o Hyperaldosteronism, Hypokalemic Alkalosis, elevated renin and angiotensin o No hypertension. o Compare to Conn's Syndrome FANCONI'S SYNDROME Type II: Renal aminoaciduria, glycosuria, hypophosphaturia, cysteine deposition, rickets. THORN'S SYNDROME: Salt-losing nephritis.

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NEUROLOGICAL • • • •

CARPAL-TUNNEL SYNDROME: Compression of Median Nerve through the Carpal Tunnel ------> pain and parasthesia over distribution of Median N. FROIN'S SYNDROME: Block in CSF flow ------> xanthochromia (yellow discoloration) of CSF. ACUTE-BRAIN SYNDROME: Delirium, confusion, disorientation, developing suddenly in a person that was previously psychologically normal. GERSTMANN'S SYNDROME: Lesion between occipital area and angular gyrus ------> symptoms:

Finger agnosia, Agraphia, acalculia Right-left disorientation HORNER'S SYNDROME: Loss or lesion of cervical sympathetic ganglion ------> o Ptosis, miosis, anhydrosis o Enophthalmos (caved in eyes) KORSAKOFF SYNDROME: Loss of short-term memory in chronic alcoholism, caused by degeneration of mamillary bodies. RILEY-DAY SYNDROME: Familial dysautonomia. o o

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GASTROINTESTINAL • • • • •

MALLORY-WEISS SYNDROME: Laceration of lower end of esophagus from vomiting ------> hematemesis. Often seen in alcoholics. MALABSORPTION SYNDROME: Impaired absorption of dietary substance ------> diarrhea, weakness, weight loss, or symptoms from specific deficiencies. BARRET SYNDROME: Chronic peptic ulcer of the lower esophagus, resulting in metaplasia of esophageal columnar epithelium ------> squamous epithelium. ZOLLINGER-ELLISOHN SYNDROME: Gastrin-secreting tumor in pancreas ------> Severe peptic ulcers, gastric hyperacidity. PLUMMER-VINSON SYNDROME: Esophageal Webs, leading to dysphagis and atrophy of papillae of tongue. o Also see hypochromic anemia, splenomegaly.

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RETICULOENDOTHELIAL, HEMATOLOGIC • •

BANTI'S SYNDROME: Chronic Congestive Splenomegaly with anemia, caused by either Portal Hypertension or Splenic Vein Thrombosis. BUD-CHIARI SYNDROME: o ACUTE: Hepatic Vein Thrombosis ------> Massive ascites and dramatic death.

CHRONIC: Gradual hepatomegaly, portal hypertension, nausea, vomiting, edema, ulimately death. DUBIN-JOHNSON SYNDROME: Defect in excretion of conjugated bilirubin ------> recurrent mild jaundice. Buildup of direct builirubin in blood. CHIDIAK-HIGASHI SYNDROME: Abnormalities in leukocytes with large inclusions. o

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CRUVEILHIER-BAUMGARTEN SYNDROME: Symptoms cluster: o Liver cirrhosis o Caput Medussae o Venous hum and thrill FELTY'S SYNDROME: Rheumatoid Arthritis with splenomegaly, leukopenia, anemia, and thrombocytopenia. LOFFLER'S SYNDROME: Eosinophilia with transient infiltrates in lungs.

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UNCATEGORIZED •

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YELLOW-NAIL SYNDROME: Stop growth of nails ------> increased convexity, thickening, and yellowing of nails. o Found in Lymphedema, bronchitis, chronic bronchiectasis. COSTOCHONDRAL SYNDROME: Pain in chest with tenderness over one or more costochondral junctions. o Similar to Tietze's Syndrome but no specific inflammation. TIETZE'S SYNDROME: Costochondritis. Swelling and tenderness of the costal cartilege. MIKULICZ'S SYNDROME: Salivary and lacrimal enlargement as seen in several diseases: o Sarcoidosis o Tuberculosis o Leukemia MUNCHAUSEN SYNDROME: Malingering -- fabrication of a clinically convincing disease by an itinerant malingerer. PICKWICKIAN SYNDROME: Symptom cluster o Obesity o Hypoventilation o Somnolence

Erythrocytosis RESTLESS LEGS SYNDROME: Need to stretch legs at night before going to sleep; twitch in legs causing insomnia. STRAIGHT BACK SYNDROME: Loss of normal kyphosis of thoracic spine ------> o Straight spine o Ejection murmur o Widened cardiac silouhette on x-ray SJÖGREN'S SYNDROME: Autoimmune complex o Keratoconjuctivitis Sicca (dry eyes and mouth) o Dryness of Mucous membranes o Telangiectasias in face o Parotid enlargement o

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HEART MURMURS Download a copy of this study guide Murmur

Description

Cooing Murmur

Musical murmur

Holosystolic Murmur

Pansystolic murmur

Innocent Murmur

Functional murmur without anatomic abnormality for the murmur.

Musical Murmur

Having a musical quality

Pansystolic Murmur

Occupies entire interval of systole.

Regurgitant Murmur

Caused by leakage of an incompetent heart valve.

Indication

Hemic Murmur

Murmur heard, but no valvular lesions. Due to blood turbulence.

Anemia

Flow Murmur Austin Flint Murmur

Presystolic murmur similar to mitral stenosis, Aortic Insufficiency heard at cardiac apex. Caused by regurgitation from Aorta partially narrowing the mitral valve.

Diamond-Shaped Murmur

Crescendo-Decrescendo murmur

Aortic Stenosis Pulmonic Stenosis

Early Diastolic Murmur

Begins right after the second heart sound.

Aortic Insufficiency

Ejection Murmur

Diamond-shaped systolic murmur ending before the second heart sound, produced by the ejection of blood into the Aorta or Pulmonary Arteries

Aortic Stenosis

Cardiopulmonary Murmur

Related to movement of the heart, and disappearing when the breath is held.

Innocent

Still's Murmur

Innocent musical murmur resembling a twanging string

Innocent

Late Systolic Murmur

Diamond-shaped murmur late in systole. Often accompanied by mid or late systolic click.

Mitral Valve Prolapse (MVP)

Middiastolic Murmur

Begins after the AV valves have opened in diastole.

Mitral Stenosis

Presystolic Murmur

Occurs during late diastole, caused by contraction of the atria.

Mitral Stenosis

Pulmonic Stenosis

Narrowing of the AV valves Machinery Murmur

Continuous rumbling murmur, heard throughout systole and diastole.

Patent Ductus Arteriosus

Extracardiac Murmur

Heard over precordium, but originating from structures other than the heart

Pericardial Friction Rubs

Graham Steele's Murmur

Early diastolic murmur heard over Erb's Point.

Pulmonic Insufficiency, secondary to Pulmonary Hypertension and Mitral Stenosis.

Roger's Murmur

Loud pansystolic murmur maximal at the left sternal border.

Ventricular Septal Defect (VSD)