Signs in medicine

Global institute of medical sciences . www.gims-org.com Ph : 0091 9052887722 , [email protected]

SIGNS IN MEDICINE---IMP LIST

(A) - Aaron’s sign seen in appendicitis. On firm pressure over the McBurney’s point the patient with appendicitis will feel distress in the epigastrium or

precordial region. - Abadie’sign -– This is the test of Muscle sense .Compress or squeeze big

muscle bellies (calf,` triceps or biceps)and note whether the patient complains of pain (Abadie’sign ).This is the test of pressure sense too.

- Adler’s sign- Is seen in Ectopic pregnancy .The abdominal tenderness is fixed ,even when the patient is turned from side to side.

- Albright sign-Metacarpels are shortened in pseudohypoparathyroidism , nevoid basal cell carcinoma ,turner and Larsen .In the presence of short fourth metacarpal ,there will be a dimple at the metacarpophalangeal joint.

- Alfred Demusset sign- Bobbing of the head with each heart beat. The rapid blood flow in the carotids will push the head with each beat, thus leading to

movement of head up and down with each heart beat. - Allis sign- is seen in developmental dysplasia.

- Arm drop sign- sign suggestive of complete tear of the rotator cuff.

- Antenna sign- seen in Keratosis pilaris - Anterior drawer sign-(Bon bruise sign) for anterior cruciate ligament tear.

It is used to diagnose rupture of the cruciate ligaments .The knee should be flexed at a right angle and the upper part of the tibia is pulled forward and pushed backward. Increased anterior and posterior movements will indicate the

rupture of cruciate ligaments. - Asboe Hansen sign- (Bulla spread sign) – seen in Pemphigus

- Auenbrugger’s sign-In pericardial effusion ,an epigastric prominence is seen.

- Auspitz’s sign-When the scales of Psoriasis are removed ,pin point bleeding spots will be seen . (B)

- Babinski’s sign- By stroking the lateral aspect of the dorsum of the foot. There is contraction of tibialis anterior, hamstrings, and tensor fascia lata.

- Baccelli’s sign-Good conduction of whisper in non purulent pleural effusion.

- Ball’s sign- is seen in fetal death .There will be hyperflexion of the spine.

http://www.gims-org.com/


- Ballance sign-The dullness can be elicited on both sides in rupture of spleen .On the right side there will be shift of the dullness ,but it is constant on

the left side. - Ballentyne-Runge sign - Decrease in the abdominal circumference late in

pregnancy due to placental insufficiency - Banana sign –the frontal lobes will be concave .This is due to neural tube

defects - Barber’s chair sign in multiple sclerosis. An electric shock like sensation

which radiates in to the arms., down the back to the legs, when the patient flexes the head..

- .Barlow’s sign- Von Rosen’s sign In congenital instability of the hip joint the hips are held flexed and abducted , A click can be heard when the femoral head leaves the acetabulum

- Bastedo’s sign seen in chronic appendicitis. On inflation of the colon with air ,pain and tenderness will be present in the right iliac fossa.

- Battle’s sign-blood pigment stain behind the ear over the mastoid due to basal skull fracture (Sphenoid bone )

- Beak sign - in patients with Hypertrophic pyloric stenosis. ,abrupt cut of the barium column in the pylorus.

- Beak sign in renal arteriogram-Renal cyst.

- Becker's sign - Pulsations seen in the retinal artery. - Beevor’s sign-in patients with paralysis of lower part of rectus abdominis

the umbilicus will move upwards when the rising test is performed. The umbilicus will move downwards in paralysis of upper part of rectus abdominis

- Beheaded scottish terrior sign- Spondylolisthesis.(In oblique view) - Belly dancer’s sign- It is seen in unilateral diaphragmatic paralysis .During

inspiration the umbilicus shifts upward and toward the side of the paralysed diaphragm

- Benda’s sign- This is of importance in tuberculous meningitis. Here the child has spasm of the trapezius muscle with the result that the shoulder on affected side is raised up and at times also brought forward. The sign is elicited by

turning the head and chin to one side and if there is upward and forward lifting of the shoulder the sign is positive. It may be positive on one or both sides.

- Bergara –Warten Berg sign-Loss of vibration on elevation of the closed upper eyelid. It is the earliest sign of facial nerve paralysis.

-Bergman sign (Chalice sign)-is a finding in renal imaging studies where there is dilatation of ureter distal to a neoplasm. Such dilatation will be absent in calculus or thrombus.

- Bing sign – Pricking the dorsum of foot by a pin produces extensor response.



-Blue berry muffin sign- is seen in dermal metastases of Neuroblastoma .There will be raised purple skin lesions.

- Blue dot sign-is seen in torsion of appendix testis .The appendix that has undergone torsion may be visible through the scrotal skin.

- Blumberg’s sign – Rebound tenderness. It is seen in acute appendicitis.

- Boas sign- is helpful in differentiating acute cholecystitis from other conditions. In acute cholecystitis there is a referred pain to the right scapula. There is an area of hyperaesthesia between the ninth and the eleventh

ribs posteriorly on the right side.. - Bow’s sign-Seen in septicemia in infants. The right side of the mediastinal

shadow resembles a bow. - Bow string sign-is used in lumbar disc herniation. It is a variation of

straight leg raising test. When the leg is raised pain will occur. At the point of pain, the knee will be flexed which will reduce the pain.

- Branham’s sign- (see Nicoladoni’s sign) is seen in aretrio venous fistula .The swelling due to arteriovenous fistula disappears on applying pressure on the artery proximal to the fistula, thrill and bruit will decrease and the pulse

rate fall .the pulse pressure will return to normal. - Brim sign- is seen in Paget’s disease.

- Braxton –Hick’s sign-Intermittent uterine contractions can be detected by palpation after 16 weeks of gestation in pregnancy.

- Brudzinski’s sign is seen in meningitis Flexion of one lower limb causes flexion of opposite limb immediately. It is

the leg sign. Flexion of neck produces flexion of hips and knees. This is the neck sign. (Brudzinski’s neck Sign-Both the lower limbs should be in extended position,

with full flexion of the neck, the child flexes both his lower limbs, at the hips as well as knees. This is a common sign of meningitis in infancy. There may be minimum flexion of the lower limbs when the child has paraplegia or

quadriplegia; there is unilateral flexion of the unaffected limb. This not only helps in the diagnosis of meningitis but also in the diagnosis of hemi paresis. Brudzinski’s leg sign- Here one of the lower limbs is flexed to 45º at the hip

and 90-120º at knee. While trying to extend the lower limbs there is flexion of the opposite limb at the hip and knee. This is a positive Brudzinski’s leg sign. In children who are constantly moving the lower limbs, particularly in

the first 2-3 years of life, the test should be carried out 3 to 4 times before it is concluded as positive. If a child has weakness or paralysis of the opposite limb there may be minimum flexion at the hip and knee.)

- Brun’s sign- Excruciating headache , vertiginous episodes , coma and death due to sudden movement of the head ,if the cysts are present in the fourth

ventricle . - Bryant’s sign-in shoulder dislocation .Abnormal position of axillary folds.



- Bulge sign- Small effusion in the knee joint. Apply gentle pressure first on the medial side of the joint when the patient is lying with the quadriceps

relaxed. Watch for the bulge on the lateral side. -Button hole sign- is seen in Neurofibromatosis

(C)

- Capener’s sign- is seen in slipped epiphysis .Normally, the posterior acetabular margin will cut across the medial corner of the metaphysis. In this condition the entire metaphysis will remain lateral to the posterior acetabular

margin. - Cardarelli’s sign- transverse pulsation in the laryngotracheal tube in

aneurysms and dilatation of the aortic arch. - Carman’s Meniscus sign- A radiological finding seen in malignant gastric

ulcer. Meniscus shaped gastric ulcer with the concavity pointed towards the gastric lumen

- Carpet tack’s sign- is seen in Discoid Lupus Erythematosis (DLE) - Carvallo’s sign- In cases with ASD, the tricuspid murmur is maximal at the

lower sternal edge and increases in intensity during inspiration - Cerebriform tongue sign-is seen in Pemphigus vegetans

- Chaddock’s sign –seen in pyramidal tract lesion. Extensor response is seen after striking the skin around the lateral malleolus in a circular fashion.

- Champagne flute sign-due to portal air in NNEC.

- Chandelier’s sign-is seen in Gonorrhoea in women - Circumflex`sign-the metaphysis have some flaring and may appear V-shaped in

achondroplasia. - Chvostek’s sign -The facial nerve is tapped at its exit from the stylomastoid

foramen. This leads to brief twitching of the facial muscles, ala of the nose and the blinking of the eyelids. .Elevation of the corner of mouth may b e seen.

- Coffee bean sign- Strangulation of incompletely obstructed loop of small bowel.

- Coin test-is found in tense Pneumothorax. Place a metallic coin on the upper part of the affected chest, and percuss over the coin with another coin. Listen at the same time from the back with the diaphragm of a stethoscope. A high

pitched tympanitic bell-like metallic sound can be heard in the presence of Pneumothorax.

- Coleman’s sign- Hematoma over the floor of the mouth in fracture of body of mandible.

- Comby’s sign-is seen in measles. In early stages thin whitish patches are seen on the gums and buccal mucous membranes.



- Commando’s sign-in spastic cerebral palsy the child drags the feet like a rudder.

- Cooper’s sign- In acute appendicitis, the tenderness is elicited in the left lateral position.

- Corner’s sign- seen in scurvy. A groove will be present just above the zone of provisional calcification.

- Corrigan's sign - Dancing carotids in aortic regurgitation..

- Counting sign-in diaphragmatic paralysis ,the patient cannot count more than 10 in one breath.

- Coup’d’ongue sign- Tinea versicolor. - Courvoisier sign- Gall bladder will be palpable in patients with carcinoma

head of the pancreas. - Crack –pot sign- see Macewen sign

- Crescent sign-In hydronephrosis, crescents of contrast medium seen with in the

enlarged renal parenchyma. This is due to the contrast medium circulating in the collecting ducts compressed by the dilated calyces.

- Crowe’s sign –In neurofibromatosis , axillary freckling and speckled hyperpigmentation over the upper chest ,groin and perineal region will be present .

- Cruveilhier s sign-is seen in portal hypertension. Caput medusa due to portocaval anastomosis.

- Cullen sign-A bluish discoloration seen around the umbilicus in patients with acute hemorrhagic pancreatitis.

- Curtsy sign is seen in Sham or Urge syndrome

- Czerny’s sign-The abdomen normally bulges at the beginning of inspiration. But in patients with chorea, there is paradoxical retraction..

(D) - Dagger sign-is due to ossification of supraspinous and interspinous ligaments

in Ankylosing spondylitis . On frontal radiograph a single radio dense line will be seen.

- Dance sign- in intussusception. The right lower quadrant may feel empty to palpation in intussusception.

- Darier sign- Urticaria pigmentosa. The lesions tend to become red, itchy and urticarial if they are rubbed.

- Dalrymple sign-(Lid retraction) Staring appearance due to abnormal widening of palpebral fissures in hyperthyroidism



- Dawbarn’s sign- seen in subacromial bursitis .The pain in this condition will disappear on abduction of the arm.

- Dawson’s sign-Palmar erythema in cirrhosis of liver

- De Dance sign-The Signe de Dance – A feeling of emptiness in the right iliac fossa in acute intussusception.

- D Espine’s sign-A large mediastinal node or a mass in Bronchogenic carcinoma may transmit the tracheal sound .This can result in bronchial breath sound, whispering pectoriloquy and rarely egophony in the inter scapular region.(Below

D4) - Delbet’s sign-in aneurysm of limb’s main artery .

- Demusset sign-See Alfred Demusset sign

- Deuel’s halo sign- This is x-ray finding in intrauterine death. The usual zone of reduced density visible around the head of relatively mature fetus before delivery appears to be separated from the cranium .The density of this zone will

be similar to that of the soft tissues. This can be demonstrated radiologically within 3 days after the death of fetus.

- Dimple sign- Cart-Wheel pattern of fibroblast seen in Dermatofibrosarcoma protuberans.

- Dimple sign(Fitzpatrick sign) in Dermatofibrosarcoma protuberans. - Dock’s sign- Rib notching in corctation of aorta.

- Dog’s ear sign-in ascites .Radiodensity superior and lateral to the bladder

- Double bubble sign-is seen in the following conditions Duodenal atresia, Annular pancreas,

Duodenal stenosis - Double duct sign in ERCP- Carcinoma pancreas

- Drawer sign- see Anterior drawer sign-(Bon bruise sign)

- Dressler’s sign-Dull note in the lower part of sternum in pericardial effusion.

- Drooping lily sign- is seen in renal pelvis with duplicated collecting system. - Dubois sign- Short little finger in congenital syphilis.

- Duga’s sign-is seen in fresh shoulder dislocation . The patient will not be able to put the hand to the opposite shoulder with the elbow close to the body

. - Duroziez’s sign- diastolic murmur heard on the femoral artery on distal

compression. (E)



- Emptying sign in straw berry angioma

- Erb’s sign-seen in latent tetany. Muscular contractions can be produced by application of subthreshold electrical stimulation.

- Eye-of-the –tiger appearance- is a MRI finding in Hallevorden-Spatz disease - Ewart’s sign- (Pin’s sign) Is seen in compression collapse of the basal

segments due to large pericardial effusion.. There will be dullness on percussion, increased vocal resonance, tubular breath sounds., increased vocal resonance. and bronchial breathing are seen in cardiac tamponade due to

pericardial effusion. - Ewing sign- pericardial sign

(F) - Faget’s sign- is seen in yellow fever. Relative bradycardia is present from

the second day of the illness. - Falling fragment sign-Solitary bone cyst.

- Fat pad sign-is seen in pericardial effusion .In normal persons the parietal pericardium is separated from the epicardial fat by about 1-2 mm. This is

increased in pericardial effusion. - Felson ‘s silhouette sign- any intrathoracic mass touching the heart ,aorta or

diaphragm will obliterate that border on the chest X ray. - Fistula sign- Pressure changes can be transmitted to the membranous

labyrinth if there is a fistula in the bony labyrinth. Pressing the tragus will induce jerk nystagmus.

- Fitzpatrick sign-in dermatofibroma .There will be dimpling when the mass is squeezed on both sides.

- Flag sign- Flag sign may be seen in Kwashiorkor. The hair will be alternately normal and depigmented. The hair in cases of severe malnutrition will be hypopigmented. As the nutrition improves the pigmentation of the hair will be

normal. Hence the hair will be alternately normally pigmented and hypopigmented, giving the appearance of a flag

- Flank stripe sign- or McCort sign-in ascites. Increased distance (>2 cm) between the properitoneal fat stripe and the right colon.

- Floating membrane sign- Hydatid cyst - Floating teeth sign- in eosinophilic Granuloma.

- Flying’ W’ sign- the posterior mitral leaflet movement resembles the letter W. In partial systolic closure of the pulmonary valves there will be flying W sign

. - Football sign-In NNEC, the free air over the liver with outlining of the

falciform ligament indicates perforation and needs surgical treatment.(Pneumoperitoneum)



- Forscheimer sign- Enanthem in rubella.

- Forester’s sign-In hypotonic or Atonic cerebral palsy, when the child is lifted by holding at the axilla ,there will be flexion at the hips.

- Frederick’s sign-Increased jugular venous pulse with sharp diastolic collapse. rapid ‘Y’descent in pericardial effusion.

- Froment’s sign-in ulnar nerve paresis , Ask the patient to grasp a book firmly between the thumb and the other fingers .In normal persons the thumb will be straight while holding the book . In patients with ulnar nerve palsy the

terminal phalanx of the thumb will be flexed. - Frostberg’s inverted 3 sign-Carcinoma head of pancreas.

(G ) - Galeazzi sign- is a check for apparent thigh length on both sides. There will

be lowering of the knee on the affected side when the child lies prone with hip flexed and knee flexed..

- Gerhardt's sign - Pulsations over the spleen in aortic regurgitation. - Goodell’s sign –Softening of cervix and vagina is a sign of pregnancy.

- Gonda sign – Extensor response is elicited after forceful stretching or snapping of distal phalanx of either of the 2nd or 4th toe.

- Gower’s sign- is seen in Duchenne muscular dystrophy ,.It will be evident by 3 years of age and will be fully expressed by 5-6 years of age. Climbing upon his

own body while getting up from sitting posture. - Grasset’s sign in hemiplegia .When a patient with hemiplegia walk on heels,

there will be abnormal movements of the hands on the same side of hemiparesis. The arms will come slightly in front, with elbow bent and not taking part in co movements. There will be inability to keep the fingers stretched and together.

- Grey Turner’s sign-A bluish discoloration seen in the flanks in patients with acute hemorrhagic pancreatitis.

- Griesinger’s sign- is seen in lateral sinus thrombosis. The thrombus may extend and result in indurated tender area over the upper part of the internal

jugular vein and mastoid region. - Groove sign- Lymphogranuloma venereum (LGV) The enlarged lymph nodes are seen

both above and below the inguinal ligament. (H)

-“Halo sign”.- Severe erythroblastosis with hydrops fetalis is demonstrable by extensive edema, which elevates fat layers beneath the skin to produce a “halo sign”. The so-called “Buddha position” is also indicative of hydrops fetalis

- Halo sign in breast tumour - a narrow radiolucent ring surrounding a benign breat lesion.

- Hamman’s crunch sign -crackling ,bubbling, crunching and churning sounds heard over the precordium in pneumomediastinum..It is better heard during the



systole in left lateral position in expiration.

- Head drop sign - The patient is asked to lie down. The shoulders are raised off the bed. Usually the head also will raise but in this case the head lag will occur. Children with poliomyelitis are unable to lift the head or bring it

along the trunk, and this is known as head lag. - Head light sign- perinasal and periorbital pallor in atopic dermatitis

- Heel pad sign- Acromegaly

- Hellmen sign-in ascites. Radiolucent shadow between the lateral walls; of liver and the abdominal wall.

- Hegar ‘s sign-Softening of the isthmus or the lower segment of the uterus This can be seen at 6 -12 weeks of gestation.

- Hertoghe’s sign- Loss of lateral third of eyebrow in atopic dermatitis - Hick’s sign-is seen in pregnancy. There is light, painless irregular uterine contractions which increase in frequency and intensity as the pregnancy

advances. - Higoumenaki’s sign-Enlargement of the medial end of the clavicle which is a

late feature of syphilis. - Hill's sign-is seen in Aortic Regurgitation .The systolic pressure in the

lower limb is more than that of the upper limb .Normally this pressure difference will be less than 20 mm of Hg. The severity of the aortic regurgitation can be assessed by measuring this difference.

- Mild Aortic Regurgitation - 20-40 mm of Hg. - Moderate Aortic Regurgitation - 40 -60 mm of Hg. - Severe Aortic Regurgitation - >60 mm of Hg.

- Hip sign - The lower limbs of a preterm baby can be abducted for more than 160 degrees

- Hoffman’s sign –is significant of pyramidal lesion. The terminal phalanx of middle finger to be grasped by the examiner. The hand to be pronated. Sharp

flickering movement of terminal phalanx will produce adduction and flexion of the thumb and flexion of the other fingers.

- Homan’s sign-is positive in venous thrombosis. Tenderness can be elicited indirectly by forcible dorsiflexion of the foot with the knee extended.

- Hook sign-In acute fulminating tenosynovitis there will be flexion of finger with pain on extension.

- Hoover’s sign –is seen in pleural effusion .There will be decreased chest movements on the affected side in pleural effusion.

- Hoover’s sign(for unilateral weakness or paralysis of one leg )- is done to differentiate between paralysis and Pseudoparalysis of one leg .The examiner’s hand is placed under the heel of the paralysed leg .Now ask the patient to raise

the normal leg against resistance .In normal individuals the examiner can feel the pressure by the normal leg ..This will be absent if the leg is weak or paralysed.



- Hutchinson’s sign- In Herpes Zoster ophthalmicus, when the tip of the nose is

involved ,the eye also will, be involved. This is because both the area are supplied by nasociliary nerve.

- Hyppocratic sign- Succussion splash present in pyopneumothorax. ( I )

- Inverted mustache sign- seen in x -ray chest in congestive cardiac failure. (J)

- Jacquemier’s sign-(Chadwick’s sign) bluish discoloration of the vagina will be seen by about 4-8 weeks of pregnancy.

- Jellinek sign- Hyperpigmented lid in hyperthyroidism - Joffroy’s sign-Absence of wrinkling on the forehead on looking upwards in

thyrotoxocisis. (K)

- Kanavel’s sign- In infection of ulnar bursa ,there will be tenderness over the part of the ulnar bursa lying in between the transverse palmar creases.

- Kehr’s sign-pain referred to the left shoulder in rupture of spleen .The pain is due to the contact of blood in the under surface of diaphragm .The pain is mediated through the afferent fibres of the Phrenic nerve.

- Kernig’s sign-The patient lies supine .The hip is flexed and the knee is extended passively. In patients with meningitis there will be pain and spasm of

hamstrings. It is positive in meningeal irritation and sub arachnoid haemorrhage. It is relatively less important in infancy and early childhood as it may be negative

in spite of meningeal involvement. However, it is a very useful sign in older children.

- Kestenbaum’s sign- is seen in optic atrophy. The number of capillaries that cross the disc margin is reduced from a normal of 10 to 7 or less.

- Kiloh-Nevin sign-Ask the patient to form a ‘O’ with the tip of the finger and the index finger In patients with anterior interosseous syndrome, fine pinch posture is abnormal.

- Kiss –the-knee sign- Ask the child to sit and kiss the knee. In the presence of Nuchal rigidity, the child cannot kiss the knee without bending the knee.

- Kocher’s sign-Frightened, staring look in Thyrotoxicosis.

- Knuckle sign- is seen in vessel occlusion due to thrombosis .there is an abrupt tapering of the vessel distal to the occlusion.

- Kritchley’s sign (Cortical thumb) in pyramidal tract lesion. - Kussmaul’s sign- Inspiratory prominence of jugular veins in pericardial

effusion, constrictive pericarditis, restrictive cardiomyopathy.. (L)



- Ladin’s sign-is seen in pregnancy. There is softening of the medial anterior surface of the body of uterus just above the body and cervix.

- Lambda sign- Small ascending aorta seen in hypoplastic left heart syndrome

- Laminar dot sign- -seen in advanced glaucoma. - Landolfi's sign - constriction and dilatation of pupils with the heart beats

and not related to light reflex. - Lassigue sign-A positive leg rising test .It is present in sciatica, prolapsed

intervertebral disc. With the patient lying supine, ask him to elevate the extended leg .A normal person can extend up to 90 degrees. The test is positive if the movement is restricted.

- Lemon sign- See banana sign –the frontal lobes will be concave .This is due to neural tube defects.

- Leri’s sign- is seen in hemiplegia. There will be absence of normal flexion of the elbow on passive flexion of the hand at wrist on the affected side.

- Leser-Trelat sign- is seen in internal malignancy. There will be sudden appearance of large number of keratosis.

- Lhermitte’s sign- electric shock like sensation radiates down the trunk ,when the trunk is flexed .it indicates cervical cord lesion ,cervical spondylotic

myelopathy, sub acute combined degeneration of the cord, radiation myelopathy - Light house sign - alternate flushing, and blanching of the forehead in Aortic

Regurgitation - Light house sign in acute Suppurative otitis media.. a pulsating discharge

will reflect the light intermittently. - Litten’s sign- in diaphragmatic palsy .There is absence of indrawing of

subcostal margin during inspiration. - Ludloff’s sign – is seen in avulsion fracture of the lesser trochanter. There

will be inability to flex the stretched leg, when the patient is seated. (M)

- Macewen’s sign (Crack – pot resonance) - a ‘cracked-pot’ sound on percussion of the skull, may be present with hydrocephalus, increased intracranial pressure and sutural separation. It is due to separation of sutures in a child having

increased intracranial tension. It is also simulated in many normal infants. To elicit this sign the child’s head should be lifted up from the bed and supported by putting the examiner’s hand under the neck In children who can sit up this

can be done in the sitting position. A sharp tap with the middle finger is given on the parietal region on each side.

- Macewen’s sign (in pericardial effusion ) - Macewen’s sign (alcohol poisoning ) pupillary sign.

- Marcus Gunn pupil sign- is seen in the patients with asymmetric, prechiasmatic, afferent conduction defect.



- Marion’s sign-seen in benign prostatic enlargement.

- Mathe’s sign-In patients with perinephric abscess, the kidney does not descend down in erect posture .In normal persons the kidney will descend in erect

posture . - Maxwell-Lyons sign-is seen in vernal conjunctivitis. A fibrinous

pseudomembrane may be seen. - Mc Burney’s sign-In acute appendicitis; pain can be elicited at the Mcburney’s

point by pressing with a finger - McEwan sign- In coma the pupil is constricted and dilates on painful stimuli.

- McMurray’s sign-In meniscus injury a painful click can be demonstrated if the flexed tibia is rotated upon the femur.

- Melting sign- In pulmonary embolism with infarction .The consolidation regresses from periphery to the centre.

- Mercedes Benz sign (Seagull sign) When gas is present in the gall stones, a characteristic dark shape will be seen in the X ray

- Milian’s ear sign- Erysipelas can spread in to the pinna (cellulitis cannot spread as there is no areolar tissue )

- Milk maid sign-Ask the patient to hold the examiner's hand,(index and middle fingers can be placed together).Feel for the uniformity in the force of

contraction by the patient. Ask the patient to hold the fingers of opposite hand and compare with the other side. In the affected side there will be alternating forces (contractions and relaxations),as like milking of a cow.

- Meniscus sign- seen in X-ray , when a mobile mass is present in the pulmonary cavity due to aspergillus fungal ball

- Moebius sign –Lack of convergence of the eye ball in thyrotoxocisis.

- Moniz sign – Extensor response is seen after forceful passive plantar flexion of ankle

- Moses sign-In venous thrombosis, pain can be elicited by squeezing the calf muscles.

- Moulage sign-is seen in Malabsorption syndrome .It is due to flocculation and segmentation of barium and mucosal thickening.

- Moyniham’s sign- is acute cholecystitis. - Muller's sign - Pulsations seen in the uvula, in aortic regurgitation.

- Munson’s sign- is seen in keratoconus. There will be bulging of the lower eye lid when the patient looks down.

- Murphy’s Sign: Ask the patient to breathe in deeply and palpate for gall bladder. At the height of inspiration the breath is arrested with a gasp as the



mass is felt. This is the sign of acute cholecystitis. (N)

- Naffziger’s sign-Stand behind the patient and look vertically downwards in the plane of super ciliary ridges .The eye balls can be seen protruding out of this

plane if proptosis is present. - Napkin ring sign-Annular carcinoma of colon.

- Nashe’s sign- Increased pulmonary blood flow in moderate and severe VSD.

- Naunyn’s sign-See Murphy’s sign - Nicoladonis sign- see -Branham’s sign

- Nicolsky’s sign-Separation of the epidermis on giving pressure over the skin. Pemphigus vulgaris, TEN –Toxic Epidermal necrolysis, porphyria, Stevenson

Johnson’s syndrome, Staphylococcal scalded syndrome. (O)

- Oil drop sign- In psoriasis .there is discolouration of nail bed. - Ollendorf sign- is seen in secondary syphilis. The papule is tender .

- Olliver’s sign-Upward and down ward movement of the trachea can be seen in patients with COPD. The chin should be raised and upward pressure should be

applied over the trachea. A downward traction can be felt on the trachea. This is known as tracheal tug.

- Oppenheim’s sign – Heavy pressure is applied by the thumb and index finger from above downwards over the anterior surface of tibia (to its medial side). The extensor response usually occurs towards the end of the stimulation.

- Ortolani’s sign-Ortalani’s sign of jerk is the earliest sign of congenital dislocation of hip. By holding the limbs with the hip and knees flexed ,abduc t

the hip joint.Placea finger over the greater trochanter.A click can be felt as the femoral head slips in to the acetabulum.

- Osiander’s sign will be seen in pregnancy due to -increased vaginal pulsations - Osler’s sign- Alkaptonuria

(P ) - Panda’ sign- bilateral periorbital haematoma in a patient with a fracture of

the anterior cranial fossa. - Pardee’s sign- It is an electrocardiogram finding in myocardial infarction. A

few hours after the infarction there will be a Q wave and S-T segment is elevated.

- Pastia’s sign-is seen in scarlet fever .Residual petechial lesions in the antecubital fossa.

- Peroneal sign-Seen in latent tetany. Tapping the peroneal nerve at the neck of the fibula will produce dorsiflexion and abduction of the foot.(eversion of foot )



- Patellar apprehension sign-apply lateral pressure to the patella with the knee

extended to 30 degrees .and the quadriceps relaxed .The patient fears that the patella may be dislocated and extends the knee thereby relocating the patella to the normal position.

- Patellar tap sign- is seen in knee joint effusion. The effusion delays the patellar tapping against the femur. ,when it is pressed firmly and quickly.

- Pedestal sign- is seen in cementless total hip arthroplasty, when there is prosthetic loosening of the femoral stem

- Pelken’s sign- is seen in scurvy. Thickened zone of provisional calcification protruding beyond the border of the shaft.

- Pen Britton sign-In retrosternal thyroid, on lifting the upper limbs ,the face is suffused, due to the pressure by the thyroid on the SVC

- Penetrating sign-A radiological finding in benign gastric ulcer. The ulcer crater should project from the contrast filled lumen and erode in to the stomach

wall rather than in to the mass in the stomach wall. - Phalen’s sign-In carpel tunnel syndrome ,the signs and symptoms will increase

on flexion of the wrist .On straightening these will improve. This is also known as Wrist flexion test..

- Phelp’s sign is seen in Glomus jugulare. - Pipe stem sign- is seen in Ulcerative colitis.

- Pillow sign- hairs on the pillow on getting up in netherton’s syndrome.

- Platysma sign of Babinski- Loss of contraction on eversion of lower eyelid or retraction of angles of mouth..

- Prayer sign-Is seen in diabetes. It is due to limited joint mobility (Cheiroarthropathy) There is inability to extend, the interphalangeal joint to 180 degree or limited joint mobility of interphalangeal joints of at least one

finger bilaterally. - Prehn’s sign- is seen in epididymo -orchitis .On elevation of the testis the

pain increases in torsion and in epididymo-orchitis the pain decreases. - Pronator sign-Ask the child to hold the hands above the head with the palm

facing each other for some time. The patient will not be able to hold it in same position. The hand on the affected side will be pronated and the palm will face outwards

- Pseudo-babinski's sign The plantar extensor response may be seen in the absence of

pyramidal tract lesions in the following conditions 1) Voluntary withdrawal 2) In plantar hyperaesthesia

3) Strong or painful stimulus, 4) In extrapyramidal lesions



- Pseudo Darrier sign- Congenital smooth muscle hamartoma

- Puddle’s sign -To diagnose minimal ascites. The patient is put in knee chest position .Percuss the abdomen towards the umbilicus to elicit the dullness.

(Q ) - Quinke's sign – (In aortic regurgitation) There will be alternate flushing and

blanching in the nail bed. (R)

- Raccoon eye sign-is seen in fracture of the base of the skull. Bilateral ecchymosis and swelling of the upper eye lids will be present..

- Red dot sign-Abdominal wall is discolored with focal or diffuse erythema reflects underlying peritonitis. This sign is seen in neonatal necrotizing enterocolitis.

- Reisser’s sign-iliac apophysis fuses with the iliac bone at maturity .This indicates a completion of growth. There will be no worsening of Scoliosis.

- Reversed 3 sign in barium x ray- Coarctation of aorta.

- Rib notching sign is seen in coarctation of aorta. - Rigler sign- The bowel wall will be outlined by air inside and outside, in

Pneumoperitoneum. - Rim sign-In severe hydronephrosis some times only a thin rim of the contrast

will be seen outlining the kidney. This is due to the contrast medium circulating in the capillaries compressed by the dilated calyces.

- Robert’s sign- appearance of gas shadow in the heart and great vessels by 12 hours of fetal death

- Romana’s sign- in Chaga’s disease ,.there will be unilateral painless oedema of the periorbital tissues .it is due to infection through the conjunctiva.

- Romberg’s sign-It is a test to find out the loss of position sense. It is special test to find out the Co-ordination of the lower limbs. The patient is asked to stand with his feet close together with both his eyes opened and

closed. If Romberg’s sign is present as soon as the patient closes his eye, he begins to sway or may even fall, It signifies sensory ataxia.

- Rope sign- due to constriction of hypopharynx in poliomyelitis. There is acute angulation between the chin and larynx due to weakness of the Hyoid muscles.

- Rosenbach’s sign - Pulsations of the liver in aortic regurgitation. - Rossolimo’s Sign- Plantar surface of the Great toe is tapped with a hammer or

flick the distal phalanges of the toes into extension and then allow them to fall back to their normal position. In pyramidal tract lesions, there will be plantar flexion of all the other toes including the Great toe. (This is

equivalent of Hoffman’s sign of the upper limbs) - Rotch’s sign- Flat note in the cardio hepatic angle on the right side in



pericardial effusion .

- Rovsing’s sign-In appendicitis, when the abdomen is pressed on the left iliac region ,there will be pain in the right side. This is due to the stretching of the inflamed peritoneum on the right side.

(S) - Sail sign- The sail shaped shadow of the thymus in the upper mediastinal

shadow. - Sandwich sign- Mesenteric adenopathy.

- Schamroth’s sign .This is seen in clubbing .Normally when the thumbs are placed in close approximation to each other so that the nails are facing each

other a quadrangular space can be seen in between the thumbs. In clubbing (Grade II or more) of the fingers this space will be obliterated. This is called Shamroth sign.

- Scarf sign- The elbow crosses the midline when the arm is crossed across the chest .Keep the head in the midline pull the hand across the chest .The elbow

will cross the midline in preterm babies.. - Schwartz sign- is seen in Otosclerosis. A pink tinge may be seen due to

otospongiotic mass (Flamingo’s tint) - Scimitar sign- Crescentic shadow (Curved Turkish sword shaped shadow) of

vascular density along the right border of the cardiac silhouette. This is due to anomalous pulmonary vein draining in to the inferior vena cava.

- Scottish dog sign- is seen in spondylolysis. The defect is in the pars interarticularis.. It appears like a scottish dog wearing a collar .

- Sea gull sign- See Mercedes Benz sign - Sectoral sign- is seen in Avascular necrosis of femoral head. The internal

rotation of the hip will be full with hip extended ,but will be grossly restricted with the hip flexed.

- Seidel’s sign- Sickle shaped extension of the blind spot above or below ,or both ,with the concavity of the sickle directed towards the fixation point. This sign is seen in field defects ,in simple glaucoma

- Setting sun eye sign - Usually seen in hydrocephalus . - Normally the sclera above the upper limbus will not be visible. In hydrocephalus , eyes deviate

downward because of the impingement of the dilated suprarenal recess on the tectum. .In normal new born babies this may be visible transiently. In kernicterus and hydrocephalus it will be persistent

- Shawl sign- In dermatomyosistis .there will be erythema over the upper back and shoulders.

- Shoulder sign-The hypertrophied pyloric muscle will cause an indentation of the barium filled antrum in patients with Hypertrophic pyloric stenosis.

- Shrug sign is seen in patello-femoral osteoarthritis.There will be pain ,when the patella is compressed manually against the femur during quadriceps



contraction.

- Sore thumb sign-Acute Epiglottitis . - Signet –ring sign-seen in the x-ray of a patient with scurvy.

- Silk sign- on physical examination , thickening of the spermatic cord in children with inguinal hernia. .It is elicited by palpating the spermatic cor d

at the pubic tubercle. - Soft neurological signs –is a particular form of deviant performance on a

motor or sensory test in a neurological examination that is abnormal for a particular age. These are present in normal children at some stage of their development like .repetitive and successive finger movements, foot taps,

hopping, tandem walking. - Spalding’s sign- This is a radiological feature of intrauterine death

overlapping of the skull bones at the sutural lines and shrinkage of the skull contents in fetal death.

- Spatula sign- In tetanus, spasm of the child will be aggravated, when the child’s mouth is pressed with a spatula.

- Spooning sign – is seen in chorea. Ask the patient to stretch the arms forward and hold them parallel to the floor with the palms facing each other. The affected arm will be flexed at the wrist and extended at the metacarpophalangeal

joints. This resembles a dinner fork.( Dinner fork deformity)

- Steeple sign – in croup. - Steinberg sign- ( Thumb sign) -In Marfan’s syndrome ,Protrusion of the thumb

beyond the ulnar border of the hand ,when flexed across the palm.. - Step sign seen in

- Spondylolisthesis, - Acromio clavicular dislocation.

- String of beads sign-in dilated small bowel filled with fluid, small bubbles of gas may be trapped between the valvular conniventes

- Square root sign- on right ventricular pressure tracing in constrictive pericarditis.

- Stellwag sign-(Staring look ) Infrequent blinking in Thyrotoxicosis. - String sign-is seen in Hypertrophic pyloric stenosis. In barium meal study the

elongated pyloric canal will be seen as a single line of barium. Some times it will be seen as a double line.

- String sign of Kantor- in barium meal study.-Crohn’s disease is due to the marked narrowing of the affected bowel.

- Sulcus sign –a radiological sign in inferior dislocation of shoulder ,where the head of the humerus lies below the glenoid.



- Sun setting sign-See setting sun eye sign.

- Suzman's sign-In Coarctation of aorta collaterals are formed in the back and will cause pulsations over the back.. The pulsations are prominent over the scapula and is best visualized with the patient bending forwards.

(T ) - Target sign –Thick pylorus in the ultrasonogram in pyloric stenosis

- Tear drop sign- in orbits- Blow out fracture

- Tear drop sign- in ankle-Ankle effusion - Tent sign- In ovarian cyst ,the vaginal fornix on that side will be deep like

a tent. - Terry Thomas sign- Scapholunate dislocation

- Thinker’s sign- due to the abnormal posture of the patient in COPD.

- Thumb sign-See Steinberg sign. It is seen in Marfan’s syndrome. - Thurston-Holland sign -Intra articular fracture ,the line going through the

plate and through the part of the metaphysis. - Tinel’s sign-When a regenerating nerve is tapped at the level of regeneration

there will be a tingling sensation - Trager’s sign

This is a sign of fetal death in utero. The fetal attitude in a X-ray will be with marked curvature or collapse of spine. Loss of fetal attitude or posture is a result of decreased muscle tone .

- Trail sign- Undue prominence of clavicular head of sternomastoid muscle on one side is indicative of tracheal displacement to that side .

- Tram track sign-Double track of barium will be seen outlining the Hypertrophic mucosa in the elongated pyloric canal in Hypertrophic pyloric stenosis.

- Tram track sign-is also seen in Sturge Weber syndrome.

- Tram track sign-is also seen in membranous glomerulonephritis. - Traube's sign - Pistol shot sound in the femoral artery in aortic

regurgitation - Trendelenburg sign-in congenital dislocation of hip. Ask the patient to stand

on one leg and note the position of the pelvis. If the test is negative the pelvis will be raised on the unsupported side .If the test is positive the pelvis will drop on the unsupported side.

- Trethowan’s sign- is positive in slipped femoral epiphysis. Normally the line drawn along the superior surface of the neck passes bisecting the head of femur.

In this condition this line` passes superior to the head. - Triple bubble sign- Jejunal atresia.



- Tripod sign is seen in poliomyelitis. The child sits with the knees flexed and

both the hands placed behind him supporting on the back as if in the tripod position. On stretching the legs the meninges are stretched which aggravates the pain. By assuming the tripod position the stretching of the meninges is

avoided thereby the pain is reduced. - Troisier’s sign enlarged left supraclavicular node (Virchow’s node)due the

gastric malignancy. - Trolley track sign -Signs in Ankylosing spondylitis Three vertical linerar

lines with increased density will be seen. - Trousseau’s sign-Phlebo thrombosis of superficial veins.

- Trousseau's sign-Ischemia of the upper limb is caused by inflating a sphygmomanometer cuff above the arterial pressure for not more than 2-3 minutes

.. This will precipitate the carpopedal spasm. -Trumbling bullet sign –is seen in post-traumatic bone cyst.

- Trumpet sign- is seen in intervertebral disc herniation. Enlargement of the nerve root seconday to edema.

- Throgmorton’s sign-Extension of the suspensory ligament of the penis prior to micturition in newborn infants.

( V ) - Vacuum cleft sign- is seen in vertebra plana.

- Vallecular sign-Retention of barium in hypopharynx in patients with carcinoma of larynx.

- Vascular sign of Narath- is seen in anterior dislocation of the hip joint. The femorals are easily felt in Scarpa’s triangle.

- Verumonten sign- is seen in complete rupture of urethra. The prostate will be floating in per rectal examination.

- Von Graefe’s sign- in Thyrotoxicosis. Lag of the upper lid on downward gaze.

- Von Rosen’s sign (Barlow’s sign ) In congenital instability of the hip joint the hips are held flexed and abducted , A click can be heard when the femoral head leaves the acetabulum .

- Victor Horsley’s sign-The temperature will be 1-2 degree more on the paralysed side.

( W ) - Water Lily sign- Hydatid cyst.

- Watenberg 's sign.-The fingers of the hand to be examined should be flexed and interlocked to the examiners flexed fingers. A pull in the opposite direction

should be applied , so that the fingers of each other pull against other's resistance. Normally the thumb extends. In the presence of cortical lesions the thumb adducts and flexes.



- Wimberger’s sign—X-ray knee bilateral erosion in upper medial end of tibia. It

will be seen in congenital syphilis ,scurvy . - Winter bottom sign- is seen in Trypanosoma brucei infection African

trypanosomiasis (Sleeping sickness).The regional nodes enlarge in the posterior cervical triangle..

- Wreden’s sign- is seen in a stillborn baby. Gelatinous material more or less completely fills the external auditory meatus.

- Wrist sign-It is seen in Marfan’s syndrome. Ask the patient to grasp the wrist with the thumb and the little finger. There will be overlapping of the fingers.

- ‘W’ sitting- is seen in persistent anteversion of the femoral neck .Children sit between their feet with the hips fully internally rotated.

OTHER SIGNS- - 3 sign on paramediastinal shadow in x ray-i n Coarctation of aorta. - Sign of ridge-seen in dehydration

- Thumb sign- Acute Epiglottitis - V sign of Naclerio- Pneumomediastinum + Pneumothorax (Boorhaeve’s syndrome) - Deep lateral femoral notch sign- Tibia vara due to retarded growth of medial

half of the proximal tibial epiphysis (Blount’s disease) - Vital signs- pulse, respiration, temperature. RADIOLOGICAL SIGNS

Coffee bean sign (Bird’s beak deformity or ace of spade deformity is seen in sigmoid volvulus.

Double stomach appearance – Atresia and stenosis of duodenum. Double bubble sign- Duodenal atresia.

Meniscus sign in chest X ray- aspergillus fungal ball.

Mercedes Benz sign (Sea gull sign) – radiolucent gall stone with gas in it Triple bubble sign- Jejunal atresia

Floating membrane sign-Hydatid cyst

SIGNS ASSOCIATED WITH VARIOUS CLINICAL CONDITIONS- (A) 1) Signs in Ankylosing spondylitis

Dagger sign Trolley track sign Bamboo spine appearance

Squaring of vertebra Anderson fracture (disco vertebral fracture) 2) AORTIC REGURGITATION -PERIPHERAL SIGNS

The volume output from the left ventricle is high and also there is a diastolic run off. This causes a rapid filling of the peripheral blood vessels and rapid emptying of these vessels. This is the cause for the peripheral signs of the

aortic regurgitation. a) Demusset sign b) Light house sign - alternate flushing, and blanching of the forehead.



c) Becker's sign - Pulsations seen in the retinal artery. d) Landolfi's sign - constriction and dilatation of pupils with the heart beats

and not related to light reflex. e) Muller's sign - Pulsations seen in the uvula. f) Corrigan's sign - Dancing carotids.

g) Locomotor brachi -The pulsations in the brachial artery is seen prominently in the medial aspect of the arm, with the arm in a semi flexed position. h) Water hammer pulse-(Collapsing pulse)

i) Quinke's sign -There will be alternate flushing and blanching in the nail bed. j) Hill's sign-

k) Rosen Bach’s sign - Pulsations of the liver. l) Gerhardt's sign - Pulsations over the spleen. m) Traube's sign - Pistol shot sound in the femoral artery.

n) Duroziez murmur - a diastolic murmur is heard over the femoral artery with the diaphragm of the stethoscope when the femoral artery is compressed distally. (4 D’s Duroziez's murmur. Diastolic murmur, Diaphragm, Distal compression.)

3) Signs in appendicitis a) Aaron’s sign

b) Bastedo’s sign c) Rovsing’ s sign d) Dieulafoy’s triad

- e) Blumberg’s sign f) Cooper’s sign- In acute appendicitis , the tenderness is elicited in the left lateral position.

4) SIGNS OF ASCITES Flank stripe sign- or McCort sign- Increased distance (>2 cm

)between the properitoneal fat stripe and the right colon. Hellmen sign- Radiolucent shadow between the lateral wall of liver and the abdominal wall.

Dog’s ear sign-Radiodensity superior and lateral to the bladder 5) Signs in ASOM-

- Light house sign - Nipple sign

6) Signs in ATRIAL SEPTAL DEFECT - - Jug-handle appearance in ASD , (dilated right atrium, ventricle, and

pulmonary arteries with less prominent aortic knuckle) - Hilar dance – On fluoroscopy there is conspicuous pulsation of the pulmonary arteries.

(C ) 1) SIGNS IN CARDIAC FAILURE-

Features of left ventricular failure Cardinal signs of left ventricular failure are a) Gallop rhythm-S3 will be heard along with S1 and S2 .This is

called triple rhythm. This will be associated with tachycardia in gallop rhythm. b) Pulsus alternans c) Fine crepitations at the base of the lungs.

Features of right ventricular failure Cardinal signs of right ventricular failure are a) Elevated jugular venous pulsations



b) Hepatomegaly-soft, tender, may be pulsatile c) Oedema of dependant parts.-Pedal oedema in patients who are

standing and sacral oedema in recumbent patients. 2) CARDIOMYOPATHY

Signs of restrictive cardiomyopathy are Edema, Ascites,

Enlarged pulsatile liver Increased JVP Kussumaul’s sign

Third and fourth heart sounds. Hepatojugular reflex will be present.

3) CEREBELLAR SIGNS a) Ataxia (In co-ordination of movements) Truncal ataxia -difficulty in sitting, standing etc(occurs in vermis lesion)

b) Titubation c) Dyssynergia- Past pointing d) Intention tremor

e) Dysmetria f) Dysdiadochokinesia g) Rebound phenomenon

h) Ataxic gait i) Speech –Dysarthria. j) Nystagmus

k) Pendular knee jerk l) Hypotonia

Tandem walking-(Heel-toe )The patient is asked to walk in a straight line with the heel of the foot placed near the tip of the toes of the other leg .This will be abnormal in patients with cerebellar lesions and posterior column

lesions. Romberg test. The patient is asked to stand straight with both the feet close to each other .First the patient is asked to stand with the eyes open

and then with the eyes closed. In cases with posterior column lesions where the position sensation is lost, the patient will fall on the side of the lesion when the eyes are closed. This is because the patient adapts to the loss of position

sensation by the visual assessment of the positions. When the eyes are closed or in the dark this adaptation will be lost and the patient tends to fall down

4) SIGNS IN ACUTE CHOLECYSTITIS Cystic duct sign Rim sign

5) SIGNS IN CHOREA- Chorea-are semi-purposive ,brief ,jerky, irregular

a) Hypotonia. b) Jack in box tongue- Involuntary protrusion and retraction of the tongue.

c) Pronator sign d) Milk maid sign-(Milking sign) e) Hung up reflex- With the patient sitting on the bed with the legs

hanging freely the knee jerk is elicited. The extension at the knee joint will be maintained for some time before the leg comes down. This is called hung up reflex and occurs in the affected side.



f) Spooning sign- g) Emotional lability

h) Czerny’s sign 6) SIGNS IN CIRRHOSIS LIVER –

- Dawson’s sign - Terry nails (leuconychia ) white nails seen in thumb and index fingers .

- Dupuytren’s contracture - Clubbing - Spider angiomata

7) SIGNS IN COARCTATION OF AORTA- - Dock’s sign

- Suzman’s sign 8) SIGNS OF VERNAL CONJUNCTIVITIS.

- Maxwell-Lyons sign- - White ropy discharge - Cobble stone appearance

- Trantas spots at the limbus. 9)CORTICAL SIGNS

Astearognosis, Apraxia, Alexia, Acalculia Blindness (Cortical) Cortical Thumb, Clonus,

Discrimination (Two-Point), Dysarthria Extensor (Plantar Reflex) Fundal Changes

Growth Retardation(-In Infantile Hemiplegia),Glabellar Reflex Hypertonia, Intelligence decreased

Jerks -Exaggerated, Judgement impaired Mentation, Memory affected Neonatal Reflexes

Orofacial Apraxia, Orientation- Affected. Palmomental Reflex, Perseveration Snout Reflex, Sucking Reflex

CORTICAL SYMPTOMS Aphasia Bladder disturbances

Convulsions (D)

1) SIGNS OF SEVERE DEHYDRATION- - Depressed fontanella - Dry tongue,

- Sunken eyes, - Skin turgor- decreased - Sign of ridge-when the skin is pinched and released the ridge formed will

disappear very slowly., 2) SIGNS OF DISLOCATION

Sulcus sign –a radiological sign in inferior dislocation of shoulder ,where the head of the humerus lies below the glenoid. (E)



1) SUB ACUTE BACTERIAL ENDOCARDITIS Anemia

Clubbing- -acute, Tender Osler’s nodes- Painful, Pea sized intradermal nodes In the Pads of fingers and toes

Janeway lesions-painless, small erythematous, hemorrhagic lesions in palms and soles Splinter hemorrhages-beneath the nails

Petechiae Tender splenomegaly Microscopic hematuria

Roth spots (F)

1) False localizing signs- Increased intracranial tension will result in lateral rectus palsy due to the stretching of the abducent nerve.

2) Signs of Avascular necrosis of femoral head a) Positive Trendelenberg ‘s sign

b) Sectoral sign 3) Signs of fetal death-

- Robert’s sign - Spalding sign - Ball’s sign

- Duel’s or halo’s sign - Trager sign

4) Signs of fracture a) Crepitus b) Deformity

c) Local bony tenderness d) Abnormal mobility e) Shortening of a segment of limb

5) Basilar skull fracture Four classical signs of basilar skull fracture a) Racoon eyes- Periorbital ecchymosis in anterior basilar fracture.

b) Battle’s sign c) Hemotympanum (Fracture of the petrous ridge ) d) CSF otorrhoea /Rhinorrhea. (Fracture cribrifirm plate )

(G) SIGNS IN GASTRIC ULCER- a) Carman’s sign- is seen in malignant gastric ulcer. Meniscus

shaped gastric ulcer with the concavity pointed towards the gastric lumen b) Penetrating sign-The ulcer crater should project from the contrast filled lumen and erode in to the stomach wall rather than in to the

mass in the stomach wall. (H )

1) Signs of congenital dysplasia of hip joint - Allis sign - Galeazzi sign-

- Trendelenburg’s sign. 2) Signs of hydronephrosis-



Rim sign

3) SIGNS IN HYPERTROPHIC PYLORIC STENOSIS. a) Target sign b) Tram track sign-

c) String sign d) Beak sign e) Shoulder sign

4) SIGNS OF HYPOPARATHYROIDISM- a) Trousseau's sign-

b) Chvostek’s sign 5) EARLY SIGNS OF HYPOTHYROIDISM- Prolonged physiological jaundice,

Hypothermia, Hypotonia, Mottled skin,

(I ) 1) INTUSSUSCEPTION -

Signs of intussusception are a) Claw sign b) Pitch fork sign in barium enema

c) oiled spring deformity (K)

1) EARLY SIGNS OF KERNICTERUS- Poor feeding Lethargy

Altered cry Altered behaviour

2) SIGNS OF KNEE JOINT EFFUSION a) Patellar tap sign- b) Bulge sign

(L ) 1) Lateralizing signs In coma it will be difficult to recognize the focal neurological signs .The

following features wil indicate the side of the lesion a) Menace reflex (Asymmetric hemianopia) b) Facial weakness

c) Abnormal tone d) Response to painful stimuli e) Asymmetry in plantar response

f) Asymmetry in tendon reflexes g) Asymmetry in decerebrate and decorticate positioning.

2) SIGNS IN LIVER FAILURE- - Alopecia-Hair loss (loss of pubic and axillary hair) - Parotid swelling

- Jaundice - Abdominal distention - Ecchymoses

- Paper money skin., spider nevi, - White brittle nails - Pruritis



- Foetor Hepaticus - Palmar erythema,

- Duputryen’s contracture - Gynaecomastia - Caput medusa

- Gastrointestinal bleeds- Haematemesis - Ascites

- Oedema - Testicular atrophy - Neurological signs- Asterixis

(M ) 1) SIGNS IN MARFAN’S SYNDROME

a) Arachnodactyly-long and slender fingers and toes . b) Steinberg’s sign or thumb sign -The thumb may be adducted across the narrow palm.

c) Wrist sign- (N )

1) SIGNS OF NERVE PARESIS Ulnar nerve paresis a) Froment’s sign

b) Paper test for interosseous muscles c) Claw hand

Median nerve- paresis . Median nerve is paralysed in Carpel tunnel syndrome a) Pointing index-Ask the patient to close the fist .The index finger will be pointing.

b) Simian or Ape like hand (Ape thumb deformity)The thumb lies in the plane of the hand due to paralysis of the opponens and the short flexor muscles.

c) Inability ot flex the interphalangeal joints due to paralysis of flexor Pollicis Longus.

Radial nerve- paresis a) Saturday night palsy b) Wrist drop.

c) Finger drop, thumb drop. Winging of scapula- Paralysis of serratus anterior (Nerve of Bell-Nerve to

serratus anterior) 2) SIGNS OF NECK RIGIDITY

a) Kernig's sign b) Brudzinski sign Neck sign Leg sign

c) Lassigue sign d) Lhermitte 's sign e) Tripod sign-in poliomyelitis

3) NECROTIZING ENTEROCOLITIS Pneumatosis intestinalis

Foot ball sign- if Pneumoperitoneum is present. (O) 1) OPTIC ATROPHY



Signs of Optic atrophy Uthoff’s phenomenon- Worsening of vision during fever in hot weather

or after exercise .central conduction is slowed by increase in the body temperature (P )

1)PANCREAS SIGNS IN ACUTE HEMORRHAGIC PANCREATITIS.

a) Cullen sign b) Grey turner sign CARCINOMA HEAD OF PANCREAS

a) Frostberg’s inverted 3 sign b) Rose thorning of duodenum c) Scrambled egg appearance

d) Double duct sign 2) SIGNS IN PERICARDIAL EFFUSION

- Dressler’s sign - Rotch’s sign-Dullness over the right sternal border. - Friedreich’s sign-Rapid ’y’ descent

- Kussmaul’s sign - Pulsus paradoxus - Ewart’s sign

- Gerhard’s dullness- Dullness over the second left intercostal space. - Ewing sign

3) SIGNS IN PLEURAL EFFUSION - Ewart’s sign

4) Signs of PNEUMOPERITONIUM - Football sign - Rigler sign

- Telltale triangle

5) SIGNS IN POLIOMYELITIS - Tripod sign - Rope sign-

- Head drop sign- - Kiss –the-knee sign- Ask the child to sit and kiss the knee. In the presence of Nuchal rigidity ,the child cannot kiss the knee without bending

the knee. - Phantom hernia-Bulge seen in the abdominal wall due weakness of abdominal muscles.

6) SIGNS IN PREGNANCY a) Hegar’s sign – softening of cervix in pregnancy b) Osiander’s sign (Vaginal sign) increased pulsations through

lateral fornices .this occurs by 8 weeks of gestation. c) Goodell’s sign (Cervical sign) Softening of the cervix with bluish discoloration by 6 weeks of gestation

d) Jacquemier’s sign (Ghadwick’s sign) dusky hue of the vestibule and the anterior vaginal wall occurs by 8 weeks of gestation e) Placental sign- Cyclical bleeding occurs up to 12 weeks of

pregnancy. f) Braxton –Hick’s sign- g) Ladin’s sign



7) SIGNS IN A PRETERM-

a) Scarf sign –The elbow crosses the midline when the arm is crossed across the chest. b) Hip sign - The lower limb can be abducted for more than 160 degrees

(S ) 1) THE SIGNS OF RECENT SCARLET FEVER

a) Desquamation of palms and soles b) Pastia’s sign-

2) Signs in scoliosis Reisser’ s sign-iliac apophysis fuses with the iliac bone at maturity .This indicates a completion of growth.

3) SIGNS IN SPONDYLOLISTHESIS-

Beheaded scottish terrior sign- Scotty dog with collar sign Incomplete ring sign

Inverted Napoleon hat sign is seen in Spondylolisthesis- of the L5 vertebral body.

4) SYPHILIS Signs of congenital syphilis Wimberger sign—X-ray knee bilateral erosion in upper medial end of

tibia (T )

1) SIGNS OF LATENT TETANY- It can be elicited by the following signs a) Trousseau's sign-Ischemia of the upper limb is caused by inflating a sphygmomanometer cuff above the arterial pressure. This will

precipitate the carpopedal spasm. b) Chvostek's sign-The facial nerve is tapped at its exit from the stylomastoid foramen. This leads to brief twitching of the facial muscles.

c) Peroneal sign- d) Erb’s sign e) Hyperventilation will precipitate latent tetany.

2) THALASSEMIA Hair on end appearance in X-ray skull

3) SIGNS OF THYROTOXICOSIS- a) Von Graefe sign- Lag of the upper lid on downward gaze.

b) Stellwag sign-Infrequent blinking c) Dalrymple sign-(Lid retraction) Staring appearance d) Joffroy’s sign-Absence of wrinkling on the forehead on looking

upwards e) Moebius sign –Lack of convergence of the eye ball f) Widening of palpebral fissures

g) Jellinek sign- Hyperpigmented lid skin h) Kocher’s sign- Frightened ,staring look. 4) TUBERCULOSIS

Sign in ileocecal tuberculosis a) Fleischner sign- Inverted umbrella defect due to a wide gap between the thickened patulous ileicecal valve and narrowed ulcerated terminal



ileum . b) Stierlin’s sign- Th e terminal ileum empties in to the stenotic

ascending colon with non-opacification of the fibrotic and contracted caecum. (V)

1) SIGNS IN DEEP VEIN THROMBOSIS a) Moses’ sign-On pressing the calf muscles directly ,tenderness will be present

b) Pratt’s sign-Calf tenderness on squeezing the calf from the sides. c) Homan’s sign-Calf tenderness on forced ankle dorsiflexion.

d) Phlegmasia alba dolens-Painful white leg. e) Phlegmasia cerula dolens-Painful blue leg

2) SIGNS OF VITAMIN DEFICIENCIES a) Signs of Vitamin A deficiency Bitot’s spots

Xerosis (Corneal & conjunctival) Keratomalacia Toad skin-Phrynoderma

b) Signs of Vitamin D deficiency-Rickets-Bossing of skull, Rachitic rosary, Harrison sulcus, genu varum ,genu valgus, Genu recurvatum

Hot cross bun appearance of skull, widening of wrists, double malleoli, Craniotabes

X ray signs in Rickets – X-ray wrists - Cupping and fraying - saucer like epiphyseal end

c) Signs of Vitamin K deficiency-Petechiae, purpura d) Signs of Vitamin E deficiency-Anemia (hemolytic)

e) Signs of Vitamin B deficiency - Angular stomatitis,cheilosis-Pellagra

Beri Beri-Thiamine, Edema-Wet beri beri, neuritis –Dry Beri beri Dermatitis –Niacin-Casal necklace Glossitis

Jerks- Ankle jerk (Vitamin B12 ) Tongue –Magenta red tongue-in riboflavin deficiency

Beefy red tongue(Red ,painful ,swollen)-Niacin deficiency Bald tongue- Vitamin B 12 deficiency. Vascularisation of cornea , Angular stomatitis ,Angular blepharitis - Riboflavin

deficiency . Keratitis Seborrhoeic dermatitis -Face ,Scrotum.

f) Signs of Vitamin C deficiency-Bleeding gums, woody leg SIGNS IN SCURVY-Bony changes are more around the knee joint

a) Corner sign –Projection of the white line laterally away from the limit of the shaft will lead to formation of spur or marginal cleft.

b) Pelken’s sign-Pelken spur- due to fracture of the Metaphyseal corner. c) Wimberger’s sign



d) White line of Frenkel Thickened provisional zone (The zone of provisional

calcification at the epiphyseal ends of long bones.) White line of Frenkel is due to increased density at the ends of long bones.

e) Pseudoparalysis of parrot f) Signet –ring sign- Signet ring appearance of epiphysis. ( Ring like epiphysis

) The rarefied epiphyseal centres may be sharply outlined which is termed signet ring.

g) Trummer feld zone (fragmented metaphysis)- Trummefeld zone is rarefaction proximal to the white line.

h) Ground glass appearance of the shaft (Due to rarefaction) i) Pencil cortex-Thinning of the cortex

MISCELLANEOUS- 1) Soft neurological signs - Buttoning cloths, tying shoes, movements of

hands. 2) Conditions associated with cherry red spot- Sphingolipidoses (Tay sach’s disease –GM 2 type 1, Sandhoff variant)

Niemann-Pick disease Metachromatic leucodystrophy Mucolipidoses.

3) Tension signs in lumbar disc herniation Lasegue’s test

Bow string sign Sitting root test

4) Babinski’s sign - By stroking the lateral aspect of the dorsum of the foot Positive response

- There is contraction of Tibialis anterior, hamstrings, and tensor fascia lata. Components

1) Dorsiflexion of great toe 2) Extension and fanning of other toes 3) Dorsiflexion of their ankle 4) Flexion of the knee

5) Flexion of the hip The other methods of eliciting plantar extensor reflex - In pyramidal tract lesions, there is an increase in the reflexogenic area.

Hence the reflex may be elicited even by stroking the skin high above in the leg. a) Oppenheim’s sign – Heavy pressure is applied by the thumb and index finger

from above downwards to anterior surface of tibia (to its medial side). The extensor response usually occurs towards the end of the stimulation. b) Gordon’s reflex – Squeezing or applying deep pressure to calf

muscles or tendo-achilles produce extensor plantar response. c) Chadock’s sign – Extensor response is seen after striking the skin around the lateral malleolus in a circular fashion.

d) Bing sign – Pricking the dorsum of foot by a pin produces extensor response. e) Moniz sign – Extensor response is seen after forceful passive plantar flexion of ankle.



f) Gonda sign – Extensor response is elicited after forceful stretching or snapping of distal phalanx of either of the 2nd or 4th toe.

g) Brissaud’s reflex – In patients with absent toe or amputated toe the plantar extensor response cannot be seen by observing the great toe since such cases look for the contraction of the tensor fascia lata.

PSEUDO-BABINSKI'S SIGN The plantar extensor response may be seen in the absence of pyramidal tract lesions inn the following conditions

1) Voluntary withdrawal 2) In plantar hyperaesthesia 3) Strong or painful stimulus,

4) In extrapyramidal lesions 5) Release reflexes a) Hoffman’s sign –The terminal phalanx of middle finger to be grasped by the

examiner. The hand to be pronated. Sharp flickering movement of terminal phalanx will produce adduction and flexion of the thumb and flexion of the other fingers

signifies pyramidal lesion. b) Rossolimo’s Sign-Plantar surface of the Great toe is tapped with a hammer or flick the distal phalanges of the toes into extension and then allow them to

fall back to their normal position. In pyramidal tract lesions, there will be plantar flexion of all the other toes including the Great toe. (This is equivalent of Hoffman’s sign of the upper limbs)

X-RAY SIGNS The X-ray changes (in the skull) in increased intracranial tension Widened sutures

Erosion of posterior glenoids Silver beaten appearance, Deep sella turcica

- Air crescent (Meniscus) sign- when an intracavitary body is surrounded by a crescent of air.(In fungal ball aspergilloma ) - Bare area sign- is seen in pleural effusion .The peritoneal ligament prevents

ascitic fluid from extending over the entire posterior surface of the liver, where as in pleural space, the pleural fluid may extend over the entire posterior costophrenic recess behind the liver.

- Double bubble sign- Duodenal atresia - Double decidual sign-in normal intrauterine pregnancy - Golden’s sign-hilar mass with collapse.

- Hoffman Rigler’s sign-to assess the left ventricular enlargement in a lateral film . ?he distance from the posterior aspect of the inferior vena cava to the posterior border of the heart horizontally at a level 2 cm above the

intersection of diaphragm and inferior vena cava. - Interface sign- is seen in pleural effusion .interface between the spleen and the pleural fluid will be less sharp than that of between the liver spleen

and ascites. - Nicoladoni’s or Branham’s sign- in proximal AV fistula. - pencil in cup deformity -Psoriatic arthritis-X ray shows pencil in cup

deformity of distal inter phalangeal joints. - Rail road calcification- Struge –Weber syndrome - Westermark’s sign - an area of pulmonary under perfusion in acute massive

pulmonary embolism. There is focal oligemia in the embolised zone. ANGIOGRAPHY

- Sting of beads –Segmental irregularity of medium and small sized arteries in fibromuscular dysplasia. PYELOGRAM-



- Ring sign- papillary necrosis. BARIUM MEAL

- Frostberg’s inverted 3 sign- in carcinoma head of pancreas ERCP - Double duct sign in carcinoma head of pancreas.

BARIUM ENEMA- - Claw sign (Pitch fork sign) in intussusception. FIRST SIGNS

1) First sign of puberty in males –Testicular growth EARLIEST SIGNS

a) Earliest radiological sign of rickets is widening of epiphysis b) Earliest clinical sign of rickets in 6 months old child is Craniotabes. c) Earliest clinical sign of Volkman ischemic contracture –Passive stretch pain.

- Ortalani’s sign of jerk is the earliest sign of congenital dislocation of hip. - Earliest sign of clubbing- increased fluctuation of the nail bed. (loss of normal onychodermal angle is a reliable sign)

- Early sign in scurvy is seen around the knees The following are some conditions with their early signs.-

- Ectropion- Visible punctum - Retrolental fibroplasia- New vessel formation - Siderosis- Radial opacities in the lens

- Sympathetic ophthalmitis- Keratic precipitates - Glaucoma- Ring of blind spot - Encephalitis lethargica- Ptosis

- Basal cell carcinoma- Field defect - Myositis ossificans- Limitation of movement, firm lump in front of the elbow. DEFINITE SIGN

Osteomyelitis-Periosteal new bone formation.(appears by the end of second week ) Fracture- presence of a deformity in a long bone after injury


Signs in medicine

Health & Medicine

Transcript of Signs in medicine