Signs and Hallmarks

7/25/2019 Signs and Hallmarks

1/15

DIGESTIVE SYSTEM AND ABDOMENDIGESTIVE SYSTEM

GI TRACT

Goodsall's Rule Softening of the vaginal part of the cervix during the first trimester

Chilaiditi

Syndrome

Rare condition when pain occurs due to transposition of a loop of large intestine (usually

transverse colon) in between the diaphragm and the liver, visible on plain abdominal X-ray or chest

X-ray

INTUSSUSCEPTION

Dance's Sign Empty RLQ (retracted right iliac fossa)

APPENDICITISAaron's Sign Epigastric pain with pressure on McBurney's point

Dunphy Sign Increase in abdominal pain on coughing

Markle Sign RLQ pain on dropping from standing on toes to heels

Mc BurneysPoint2/3 of the way lateral on a line from umbilicus to anterior superior iliac spine (corresponds to

junction of vermiform appendix and cecum)

Rosenstein's SignTenderness in the right lower quadrant increases when the patient moves from the supine position

to a recumbent posture on the left side

Rovsing's Sign Palpation of LLQ elicits pain in RLQ

Sherren's Triangle Area of hyperaesthesia over the right lower abdomen

Hampton's Line Line on barium meal indicating mucosal oedema associated with ulcer

ACCESSORY

LIVER

Councilman Body eosinophilic globules in liver

Mallory BodyAn inclusion found in the cytoplasm of liver cells.

Mallory bodies are damaged intermediate

filaments within the hepatocytes

BILIARY

Boas' Sign Dermal hyperaesthesia at inferior angle of R scapula

Courvoisier's Law Palpable gall bladder w/ painless jaundice unlikely to be cholelithiasis

Charcot's

Cholangitis Triad/

Reynolds' Pentad

Jaundice, fever and chills, RUQ pain

Charcot's triad + hypotension and altered mental state

CHOLECYSTITIS

Murphy's Sign Hesitation on inspiration while gall bladder is palpated

Lpine's SignPositive when effleurage (light percussion) with crooked third finger at the point of the gallbladder

projection to anterior abdominal wall (Kerr's point) elicits pain

Nardi Test Administration of morphine and neostigmine reproduces sharp LUQ pain; not in general use

ABDOMINO PELVICPERITONEU

M

Blumberg Sign Rebound tenderness

Rigler's Sign Gas outlines both mucosal and serosal surfaces of bowel

HERNIA

Howship

Romberg SignPain from an obturator hernia radiating to knee

Hannington-Kiff

SignAbsent thigh adductor reflex with positive patellar reflex

OTHERFothergill's Sign

Anterior abdominal mass which does not cross the midline and is still palpable when abdominal

wall muscles are tensed

Carnett's Sign Supine patient lifts head from bed;painabdominal wall ; pain intraperitoneal

ABDOMINAL

GENERAL

SPLEEN/LUQ

Ballance's Sign Percussive dullness left flank, LUQ, percussive resonance right flank

Traube's Sign Dull percussion sound over Traube's space

Castell's Sign

Placing the patient in the supine position. With the patient in full inspiration and then full expiration, percuss

the area of the lowest intercostal space (eighth or ninth) in the left anterior axillary line. If the note changes

from resonant on full expiration to dull on full inspiration, the sign is regarded as positive. The resonant note

heard upon full expiration is likely to be due to the air-filled stomach or splenic flexure of the colon. When the

patient inspires, the spleen moves inferiorly along the posterolateral abdominal wall. If the spleen is enlarged

enough that the inferior pole reaches the eighth or ninth intercostal space, a dull percussion note will be

appreciated, indicating splenomegaly.HEMORRHAGE

Cullen's Sign Ecchymosis around umbilicus predicts onset of acute pancreatitis

Grey Turner's Sign Flank ecchymosis


2/15

CIRCULATORY SYSTEMHEART DISEASE

HEART

MURMUR

SYSTOLIC HEART MURMUR: BENIGN PAEDIATRIC HEART MURMUR

Still's murmur systolic ejection sound ; vibratory/musical; best heard at left lower sternal border

DIASTOLIC HEART MURMUR: PULMONIC REGURGITATION (

Graham Steell murmur) pulmonary regurgitation murmur in patients with pulmonary hypertension secondary to mitral stenosis

AORTIC INSUFFICIENCY

(Austin Flint murmur)

carey coombs murmurmid-diastolic rumble

MITRAL REGURGITATION

(Presystolic murmur)

AORTIC

INSUFFICIENCY

Watson's water hammer

pulse/bounding forceful pulse elicited with postural manoeuvres

Corrigan pulse carotid pulsations with abrupt ascending and descending phases

De Musset's sign head nodding in time with heartbeat

Duroziez's sign double bruit heard over femoral artery when it is compressed distally (see Traube's sign)

Mller's sign visible pulsation or bobbing of uvula

Quincke's sign visible pulsation in ungual capillary bed

Austin Flint murmur mid-diastolic rumble heard at apex

Mayne's sign systolic blood pressure drop of >15mmHg on raising arm

ENDO-

PERICARIDUM

ENDOCARDITIS:

Roth's spot retinal haemorrhages with pale centres seen at fundoscopy

Osler's node painful red lesions on the pads of the fingers and plantar surfaces

Janeway lesion/ palmar or plantar erythematous or haemorrhagic papules

Bracht-Wachter bodies yellow-white spots in the myocardium

PERICARDIUM

CARDIAC TAMPONADE/PERICARDIAL EFFUSION:

Beck's triad hypotension, increased central venous pressure (JVP), distant heart sounds

Ewart's sign percussive dullness, aegophony and bronchial breath sounds at L scapular tip

OTHER

RHEUMATIC FEVER:

Anitschkow cell

Aschoff body foci of interstitial inflammatiuon in the myocardium and elsewhere

EKG

(Osborn wave) positive deflection at QRS-ST junction

ANGINA PECTORIS (

Levine's sign) patient clenches fist over chest when asked to describe pain

Gallavardin

phenomenondissociation of musical and noisy elements in ejection murmur

VASCULAR DISEASE

ARTERIAL

AORTIC ANEURYSM

(Cardarelli's sign, left displacement of trachea elicits palpable pulsation of same

Oliver's sign) caudal movement of trachea with systole

PULMONARY EMBOLISM

(McConnell's sign) echocardiography finding of akinesia of the mid-free wall of the right ventricle but normal motion of the apex

RADIAL ARTERY SUFFICIENCY

(Allen's test) tests for presence of palmar ulnar-radial anastomosis (palmar arch)

PSEUDOHYPERTENSION

(Osler's sign) falsely elevated bp reading due to incompressibility of calcified vessels

THROMBUS

(Lines of Zahn)

Adson's sign obliteration of radial pulse with manoeuvres

ARTERIOVENOUS FISTULA

(Nicoladoni sign)

VENOUS

Friedreich's sign collapse of distended neck veins in diastole

Caput medusae distended veins radiating from umbilicus

Kussmaul's sign increased jugular distension on inspiration

DVT

Bancroft's sign pain on anterior, but not lateral, compression of calf

Homans sign knee bent, ankle abruptly dorsiflexed, popliteal pain

Lisker's sign tenderness on percussion of antero-medial tibia

Louvel's sign increased pain along vein with valsalva; proximal pressure prevents this

Lowenberg's sign immediate pain on inflating blood pressure cuff around calf

Peabody's sign calf muscle spasm when raising the affected leg with the foot extended

Pratt's sign pain elicited by compression of posterior calf

Rose's sign Warm, stiff feeling of skin when affected leg is pinched

Trendelenburg test

SUPERIOR VENA CAVA SYNDROME

(Pemberton's sign) arms elevated over head elicits facial plethora, distended neck veins and inspiratory stridor


3/15

ENDOCRINOLOGY, NUTRITION AND METABOLISMENDOCRINE DISEASE

HYPOGLYCEMIA Whipples triad

1.symptoms associated with hypoglycaemia

2. measured low serum glucose

3. relief of symptoms with administration of glucose p.o. or iv

GRAVES DISEASE/

GOITRE

EYELID

Abadie's sign of exophthalmic

goiterlevator palpebrae superioris spasm

Boston's sign spasmodic ptosis on downward gaze

Dalrymple's sign widened palpebral opening

Stellwag's sign infrequent and/or incomplete blinking, accompanied by Dalrymple's sign

LID LAG

Von Graefe's sign ' lid lag'; immobility of upper lid on downward gaze

Griffith's sign lid lag of the lower eyelid on upward eye movement

EXTRA OCULAR MUSCLES

Mbius sign inability to maintain convergence of eyes

HYPOTHYROIDISM Queen Annes sign

NUTRITIONVITAMIN B12DEFICIENCY

Schilling test affected areas of cervix fail to stain brown with iodine solution

RICKETS Harrisons groove rib deformity at the lower thorax

CARBOHYDRATE Benedict solution reagent for presence of monosaccharides

METABOLIC DISORDERS

HYPOCALCAEMIAChvostek sign tapping over facial nerve elicits abnormal muscle contraction(s)

Trousseau sign of latent tetany in hypocalcaemia, occlusion of brachial artery induces carpal spasm

PKU Guthrie test

others Beutler test


4/15

EYES AND EARSEYES

ADNEXA

LACRIMAL:

Schirmer's test quantifies lacrimal secretion

EYELID:

Abadie's sign of

exophthalmic goiterlevator palpebrae superioris spasm

Boston's sign spasmodic ptosis on downward gazeDalrymple's sign widened palpebral opening

Stellwag's sign

GLOBE

PUPIL:

Argyll Robertson

pupilsight-near dissociation

Adie pupil dilated pupil, poorly reactive but with normal near accommodation

Marcus Gunn pupil

IRIS:

Fleischer ring

Kayser-Fleischer ring ring of brownish copper deposit at corneo-scleral junction

Brushfield spots greyish-white spots at periphery of iris

Lisch nodule yellow brown hamartomata on iris

CONJUNCTIVA:

Bitot's spots spots of keratin deposition in the conjunctiva

Arlt's line

RETINA:

Hollenhorst plaque cholesterol embolus(i) of retinal artery(ies)

Roth's spot retinal haemorrhages with pale centres seen at fundoscopy

Fuchs spot

OTHERS:

Alexander's law describes nystagmus in vestibular lesions

Hirschberg test corneal reflection centred (-) or not centred (+) on pupil

Siegrist streaks hyperpigmented sreaks parallel to choroidal vesselsHudsonStahli line

EARSAUDITORY:

Rinne test comparison of air conduction to bone conduction differentiates sensorineural from conductive deafness

Weber test

VESTIBULAR:

DixHallpike test Elicitation of extreme vertigo upon lateral movement of a patient's head when lying in a supine position

Unterberger test patient walks in place with eyes closed;direction of rotation indicates vestibular lesion on that side


5/15

HEMATOLOGYINCLUSION BODIES

ERYTHROCYTE

Cabot rings threadlike strands in erythrocytes

Howell-Jolly body

Pappenheimer bodies

Heinz body

NEUTROPHILDhle bodies basophilic inclusions in peripheral cytoplasm of neutrophils

PLASMA CELL

Russell bodies

MYELOBLAST

Auer rod cytoplasmic inclusions in myeloblasts

HISTIOCYTE

Birbeck granules

TESTSApt test

Coombs test

OTHERSArneth count lobulation of neutrophil nuclei

Mentzer index differentiates iron deficiency anaemia from beta thalassaemia

Virchow's triadHypercoagulability, Hemodynamic changes (stasis, turbulence) and

Endothelial injury/dysfunction


6/15

INFECTIOUS DISEASEBACTERIAL DISEASE

SYPHILIS

Hutchinson's teeth small, widely spaced incisors with notched biting surfaces

Hutchinson's triad interstitial keratitis,nerve deafness, Hutchinson's teeth

Abelin reaction presence of arsenical anti-syphilitic;obsolete

Westphal's sign

Clutton's joints painless symmetrical hydrarthroses, particularly of the knees

Dennie-Marfansyndrome

VIRAL DISEASESMEASLES Koplik's spots

Warthin-Finkeldey cell

YELLOW FEVER Councilman body eosinophilic globules in liver

Tzanck test

INCLUSION

BODIES:

POXVIRUS

Downie bodies/A

Guarnieri bodies/B

RABIES

Negri bodies

Cowdry bodies

Liebermeister's rule

Faget sign

PARASITIC DISEASESCHAGAS DISEASE

Romana's sign painless unilateral periorbital swelling

AFRICAN TRYPANOSOMIASIS

Winterbottom's sign posterior cervical chain adenopathy

MALARIA

Schffner's dots


7/15

INTEGUMENTARY SYSTEMSKIN

Asboe-Hansen Sign extension of a blister to adjacent unblistered skin when pressed

Auspitz's Sign punctate bleeding when scales are scraped

Borsari's Sign

Braverman's Sign

Crowe Sign axillary freckling

DennieMorgan Fold accentuated fold below the lower eyelidDarier's Sign dermatographia

Fitzpatrick's Sign

Florid Cutaneous

Papillomatosis

Gottron's Sign

Hutchinson's Sign lesion on tip of the nose which can presage ocular herpes zoster

Janeway Lesion palmar or plantar erythematous or haemorrhagic papules

Kerr's Sign

Koebner's Phenomenon

Koplik Spots

Leser-Trelat Sign sudden onset of multiple pruritic seborrheic keratoses

Nikolsky's Sign mild shear stress applied to skin causes bullae to form

Pastia's Sign lines of confluent petechiae in skin creases (associated with Scarlatiniform rash and strep pyogenes)

Russell's Sign scarring of the dorsum of one hand (contact with incisors when purging)

Wickham Striae white or greyish lines on the lichen planus lesions

Wolf's Isotopic

Response

NAILSAldrich-Mees' Lines

Beau's Lines transverse ridges on nails

Muehrcke's Lines paired transverse white lines on nail bed

Terry's Nails white 'ground glass' nails;absence of lunula


8/15

MUSCLES AND SOFT TISSUENEUROMUSCULAR/ SOFT TISSUE

SUPERIOR GLUTEAL

NERVE WEAKNESS

Trendelenburg

Gait

Trendelenburg's

Signpelvic tilt contralateral to 'stance leg'

THORACIC OUTLETSYNDROME

Adson's Sign obliteration of radial pulse with manoeuvres

Wright'sManeuver

Gowers' Sign

COLLAGEN

EHLERS-DANLOS

SYNDROMEGorlin Sign


9/15

NERVOUS SYSTEMCNS

HEAD, GENERAL

Battle's sign mastoid ecchymosis

Broca aphasia expressive aphasia

Kernig's sign hip and knee fully flexed, extension of knee elicits pain and/or opisthotonus

Macewen's sign

Myerson's sign inability to resist blinking when glabella is percussedStroop test reaction times for incongruent stimuli (e.g., word red printed in blue)

Wada test short acting barbiturate injected in internal carotid; lateralizes language function

Dix-Hallpike testElicitation of extreme vertigo upon lateral movement of a patient's head when

lying in a supine position

Hirano body

MULTIPLE SCLEROSIS

Dawson's fingers characteristic fingerlike appearance of lateral ventricle on mri, ct, or at autopsy

Lhermitte's sign electrical sensation down the back and into limbs with neck flexion or extension

Charcot's neurologic triad

Uhthoff's phenomenon in neurological symptoms with exercise or other increase in body temperature

OTHER

Romberg's test nability to maintain posture with eyes closed

INCREASED

INTRACRANIAL

PRESSURE

Cushing's triadelevated systolic bp, bradycardia, irregular respiration

Miller Fisher testImprovement in cognitive function after withdrawal of CSF during lumbar

puncture used to confirm diagnosis

PNS

REFLEXES OF

EXTREMITIES/CORTICOSPINAL

TRACT

COMBINATION

Jendrassik maneuver compares patellar reflex w/ and w/o distraction

LOWER LIMB

Babinski sign

dorsiflexion of the hallux with fanning of the remaining phalanges upon soft

stimulation of the lateral plantar surface of the foot

Chaddock reflex extension of big toe with stimulation of skin over lateral malleolus

Oppenheim's sign irritation downward of the medial tibia causes dorsiflexion of big toe

Westphal's sign

UPPER LIMB

Hoffmann's sign tapping distal phalanx of 3rd or 4th finger elicits flexion of same in thumb

OTHER

TORSO/LIMBS

UPPER LIMB

Froment's signpatient required to hold paper between thumb and palm (against attempt to

withdraw);ability to do so is assessed

carpal

tunnel

syndrome

Tinel sign 'DTP'distal tingling on percussion

Phalen maneuver 3060 seconds of full forced flexion of wrist elicits symptoms

LOWER LIMB

Abadie's sign of tabes dorsalis absence of pain on Achilles tendon pressure

Gowers' sign

Hoover's sign differentiates organic from non-organic etiology

Lasgue's sign better known as straight leg raise test

Trendelenburg's sign pelvic tilt contralateral to 'stance leg'

TORSO

Beevor's sign caudal movement of navel on cervical flexion

GENERAL

Todd's paresis focal weakness for as much as 48 hours after seizure

Jolly's test electromyography test using repeated stimuli to show fatiguability in myasthenia

MENTAL/ BEHAVIOURAL

Russell's sign scarring of the dorsum of one hand (contact with incisors when purging)


10/15

ONCOLOGYHEMATOLOGICAL MALIGNANCY

Russell bodies

Auer rod cytoplasmic inclusions in myeloblasts

Bence Jones protein

LYMPH NODESVirchow's node ( Troisier's

sign )Enlargement of the left supraclavicular lymph node (=Virchow's node)

Sister Mary Joseph nodule palpable lymph node in the umbilicus

Lund's node

OTHERCall-Exner bodies

LeserTrlat sign sudden onset of multiple pruritic seborrheic keratoses

Trousseau sign of

malignancyspontaneous thrombosis of multiple veins, including portal circulation

Courvoisier's law palpable gall bladder w/ painless jaundice unlikely to be cholelithiasis

Schiller-Duval body


11/15

OBSTETRICSPREGNANCY

Abderhalden reaction serum reaction;obsolete

Chadwick sign cyanosis of vulva, vagina and cervix

Goodell's sign softening of the vaginal part of the cervix during the first trimester

Hegar's sign softening of cervical isthmus appearin between 4th and 6th weeks (usually)

Ladin's sign softening of uterus; similar to Hegar's sign

Piskacek's sign palpable lateral bulge at tubal-uterine junction; present at 78 weeksVon Braun-Fernwald's sign softening of the uterine fundus at the site of implantation at 45 weeks gestation

OTHERApgar score assess health of newborn

Braxton Hicks contractions "false labour". sporadic contractions beginning as early as mid 1st trimester

hydrops fetalis (Hemoglobin Barts)

ectopic pregnancy (Spiegelberg

criteria)

fetal death (Spalding's sign)

Leopold's maneuvers determination of fetal lie

Naegele's rule method of estimating due date


12/15

REPRODUCTIVE SYSTEMFEMALE

ENDOMETRIUM:Arias-Stella's

phenomenon

Canga's bead symptom

MALE

PENIS John Thomassign

penile shadow points at affected hip (+) or unaffected hip (-) (2)

TESTICLE Prehn's sign


13/15

RESPIRATORY SYSTEMRESPIRATORY SYSTEM

OBSTRU

CTIVE

LUNG

DISEASE

COPD

Hoover's sign inward movement of lower ribs during inspiration

ASTHMA

Curschmann's spirals spiral mucus plugs found in sputum

CharcotLeyden

crystalsCHRONIC BRONCHITIS

Reid index

RESTRIC

TIVE

LUNG

DISEASE

SARCOIDOSIS

Kveim test intradermal injection of lymphatic extract from known sufferer; obsolete

DYSPNE

A

Biot's respirationquick shallow respirations followed by period of

apnea

CheyneStokes

respirationfluctuation between apnoea and tachypnoea

Kussmaul breathing laboured deep breathing with normal or reduced frequency

OTHER/

GENERA

L

CLUBBING

Schamroth's window

testidentifies clubbing of distal phalanges

Hippocratic fingers clubbing of distal phalanges

PULMONARY EMBOLISM

Hampton hump wedge shaped consolidation at periphery with base on the pleura

Westermark sign Area of oligaemia on chest x-ray

PULMONARY EDEMA

Kerley lines

Hamman's sign crepitus in sync w/ heartbeat but not respiration

Golden S sign

REFERREDSPLEEN

Kehr's sign referred pain to L shoulder


14/15

SKELETAL SYSTEM AND JOINTSJOINTS

ARTHROPATHY

OSTEOARTHRITIS

(Bouchard's

nodes/bony outgrowths on dorsa of proximal interphalangeal joints

Heberden's

node)same as bouchard's nodes, but over dip joints

DERMATOMYOSITIS(Gottron's

papules)Scaling, erythematous eruption or dusky red patches over the knuckles, elbows and knees

DEQUERVAIN'S SYNDROME

(Finkelstein's

test)

ANTERIOR SHOULDER INSTABILITY

(Jobe's test)

HIP DYSPLASIA

Barlow's

maneuverdislocation on adduction of hip

Ortolani test palpable clunk on moving hip

LOW BACK PAINWaddell's

signs)identify non-organic sources of low back pain

DORSOPATHY

LOW BACK FLEXIBILITY

Ott test

Schober test quantifies lumbar flexion

SACROILIITIS

(Larrey's sign) pain in sacroiliac area on sitting down on hard chair

TRAUMA/

ORTHOPEDICS

KNEE:

LIGAMENT

Lachman test) modified anterior drawer test with knee in less flexion

MENISCUSApley grind test manoeuvres to elicit knee pain

McMurray test knee extended, valgus stress applied, leg rotated produces palpable or audible click

LIGAMENT AND MENISCUS

O'Donoghue's

triadcoincidence of anterior cruciate injury,medial collateral injury and meniscal tear

ANKLE:

TENDON

Simmonds' test squeezing of calf fails to produce plantar flexion

SHOULDER:

ROTATOR CUFF

Hawkins-Kennedy test

LIGAMENT

Neer

impingement

sign

Jobe's test

Watson's test

SKELETAL/BONEBONE TUMOR

Codman triangle) triangular subperiosteal growth

OSTEOCHONDRITIS DISSECANS

Wilson test)

TEETHHutchinson's teeth small, widely spaced incisors with notched biting surfaces


15/15

URINARY SYSTEMURINARY SYSTEM

Addis Count quantitative cells and casts in 24hr. urine

Brewer Infarcts dark red wedge shaped areas on kidney section resembling infarcts

Murphy's Punch Sign punch tenderness at the costovertebral angle

Lloyd's Sign

Signs and Hallmarks

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