Signs in Medicine

08/01/15 4:14 pmSIGNS IN MEDICINE

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SIGNS IN MEDICINE (A)- Aarons sign seen in appendicitis. On firm pressure over the McBurneys point the patient withappendicitis will feel distress in the epigastrium or precordial region.- Abadiesign - This is the test of Muscle sense .Compress or squeeze big muscle bellies (calf,` triceps orbiceps)and note whether the patient complains of pain (Abadiesign ).This is the test of pressure sense too.- Adlers sign- Is seen in Ectopic pregnancy .The abdominal tenderness is fixed ,even when the patient isturned 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 themetacarpophalangeal joint.- Alfred Demusset sign- Bobbing of the head with each heart beat. The rapid blood flow in the carotidswill 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 diagnoserupture of the cruciate ligaments .The knee should be flexed at a right angle and the upper part of the tibiais pulled forward and pushed backward. Increased anterior and posterior movements will indicate therupture of cruciate ligaments.- Asboe Hansen sign- (Bulla spread sign) seen in Pemphigus- Auenbruggers sign-In pericardial effusion ,an epigastric prominence is seen.- Auspitzs sign-When the scales of Psoriasis are removed ,pin point bleeding spots will be seen .(B)- Babinskis sign- By stroking the lateral aspect of the dorsum of the foot. There is contraction of tibialisanterior, hamstrings, and tensor fascia lata.- Baccellis sign-Good conduction of whisper in non purulent pleural effusion.- Balls sign- is seen in fetal death .There will be hyperflexion of the spine.- Ballance sign-The dullness can be elicited on both sides in rupture of spleen .On the right side therewill 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 placentalinsufficiency- Banana sign the frontal lobes will be concave .This is due to neural tube defects- Barbers chair sign in multiple sclerosis. An electric shock like sensation which radiates in to thearms., down the back to the legs, when the patient flexes the head..- .Barlows sign- Von Rosens 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- Bastedos sign seen in chronic appendicitis. On inflation of the colon with air ,pain and tenderness willbe present in the right iliac fossa.- Battles sign-blood pigment stain behind the ear over the mastoid due to basal skull fracture (Sphenoidbone )- Beak sign - in patients with Hypertrophic pyloric stenosis. ,abrupt cut of the barium column in thepylorus.- Beak sign in renal arteriogram-Renal cyst.- Becker's sign - Pulsations seen in the retinal artery.- Beevors 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 upperpart of rectus abdominis - Beheaded scottish terrior sign- Spondylolisthesis.(In oblique view)- Belly dancers sign- It is seen in unilateral diaphragmatic paralysis .During inspiration the umbilicusshifts upward and toward the side of the paralysed diaphragm- Bendas sign- This is of importance in tuberculous meningitis. Here the child has spasm of thetrapezius muscle with the result that the shoulder on affected side is raised up and at times also broughtforward. The sign is elicited by turning the head and chin to one side and if there is upward and forwardlifting 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 earliestsign of facial nerve paralysis.-Bergman sign (Chalice sign)-is a finding in renal imaging studies where there is dilatation ofureter 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 skinlesions.- Blue dot sign-is seen in torsion of appendix testis .The appendix that has undergone torsion may bevisible through the scrotal skin.- Blumbergs sign Rebound tenderness. It is seen in acute appendicitis.- Boas sign- is helpful in differentiating acute cholecystitis from other conditions. In acute cholecystitisthere is a referred pain to the right scapula. There is an area of hyperaesthesia between the ninth and theeleventh ribs posteriorly on the right side..- Bows 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 theleg is raised pain will occur. At the point of pain, the knee will be flexed which will reduce the pain.- Branhams sign- (see Nicoladonis sign) is seen in aretrio venous fistula .The swelling due toarteriovenous fistula disappears on applying pressure on the artery proximal to the fistula, thrill and bruitwill decrease and the pulse rate fall .the pulse pressure will return to normal.- Brim sign- is seen in Pagets disease.- Braxton Hicks sign-Intermittent uterine contractions can be detected by palpation after 16 weeks ofgestation in pregnancy.- Brudzinskis 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.(Brudzinskis neck Sign-Both the lower limbs should be in extended position, with full flexion of theneck, the child flexes both his lower limbs, at the hips as well as knees. This is a common sign ofmeningitis in infancy. There may be minimum flexion of the lower limbs when the child has paraplegiaor quadriplegia; there is unilateral flexion of the unaffected limb. This not only helps in the diagnosis ofmeningitis but also in the diagnosis of hemi paresis.Brudzinskis leg sign- Here one of the lower limbs is flexed to 45 at the hip and 90-120 at knee. Whiletrying to extend the lower limbs there is flexion of the opposite limb at the hip and knee. This is apositive Brudzinskis leg sign. In children who are constantly moving the lower limbs, particularly in thefirst 2-3 years of life, the test should be carried out 3 to 4 times before it is concluded as positive. If achild has weakness or paralysis of the opposite limb there may be minimum flexion at the hip and knee.)- Bruns sign- Excruciating headache , vertiginous episodes , coma and death due to sudden movementof the head ,if the cysts are present in the fourth ventricle .- Bryants 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 jointwhen the patient is lying with the quadriceps relaxed. Watch for the bulge on the lateral side.-Button hole sign- is seen in Neurofibromatosis



(C)- Capeners sign- is seen in slipped epiphysis .Normally, the posterior acetabular margin will cut acrossthe medial corner of the metaphysis. In this condition the entire metaphysis will remain lateral to theposterior acetabular margin.- Cardarellis sign- transverse pulsation in the laryngotracheal tube in aneurysms and dilatation of theaortic arch.- Carmans Meniscus sign- A radiological finding seen in malignant gastric ulcer. Meniscus shapedgastric ulcer with the concavity pointed towards the gastric lumen- Carpet tacks sign- is seen in Discoid Lupus Erythematosis (DLE)- Carvallos sign- In cases with ASD, the tricuspid murmur is maximal at the lower sternal edge andincreases in intensity during inspiration- Cerebriform tongue sign-is seen in Pemphigus vegetans- Chaddocks sign seen in pyramidal tract lesion. Extensor response is seen after striking the skinaround the lateral malleolus in a circular fashion.- Champagne flute sign-due to portal air in NNEC.- Chandeliers sign-is seen in Gonorrhoea in women- Circumflex`sign-the metaphysis have some flaring and may appear V-shaped in achondroplasia.- Chvosteks sign -The facial nerve is tapped at its exit from the stylomastoid foramen. This leads to brieftwitching of the facial muscles, ala of the nose and the blinking of the eyelids. .Elevation of the corner ofmouth 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 ofa stethoscope. A high pitched tympanitic bell-like metallic sound can be heard in the presence ofPneumothorax.- Colemans sign- Hematoma over the floor of the mouth in fracture of body of mandible.- Combys sign-is seen in measles. In early stages thin whitish patches are seen on the gums and buccalmucous membranes.- Commandos sign-in spastic cerebral palsy the child drags the feet like a rudder.- Coopers sign- In acute appendicitis, the tenderness is elicited in the left lateral position.- Corners 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.- Coupdongue 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 renalparenchyma. This is due to the contrast medium circulating in the collecting ducts compressed by thedilated calyces.- Crowes sign In neurofibromatosis , axillary freckling and speckled hyperpigmentation over the upperchest ,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 hemorrhagicpancreatitis.- Curtsy sign is seen in Sham or Urge syndrome- Czernys sign-The abdomen normally bulges at the beginning of inspiration. But in patients withchorea, 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 inintussusception.- Darier sign- Urticaria pigmentosa. The lesions tend to become red, itchy and urticarial if they arerubbed.- Dalrymple sign-(Lid retraction) Staring appearance due to abnormal widening of palpebral fissures inhyperthyroidism- Dawbarns sign- seen in subacromial bursitis .The pain in this condition will disappear on abduction ofthe arm.- Dawsons sign-Palmar erythema in cirrhosis of liver- De Dance sign-The Signe de Dance A feeling of emptiness in the right iliac fossa in acuteintussusception.- D Espines sign-A large mediastinal node or a mass in Bronchogenic carcinoma may transmit thetracheal sound .This can result in bronchial breath sound, whispering pectoriloquy and rarely egophony inthe inter scapular region.(Below D4)- Delbets sign-in aneurysm of limbs main artery .- Demusset sign-See Alfred Demusset sign- Deuels halo sign- This is x-ray finding in intrauterine death. The usual zone of reduced density visiblearound the head of relatively mature fetus before delivery appears to be separated from the cranium .Thedensity of this zone will be similar to that of the soft tissues. This can be demonstrated radiologicallywithin 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.- Docks sign- Rib notching in corctation of aorta.- Dogs 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) - Dresslers 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.- Dugas sign-is seen in fresh shoulder dislocation . The patient will not be able to put the hand to theopposite shoulder with the elbow close to the body .- Duroziezs sign- diastolic murmur heard on the femoral artery on distal compression.(E)- Emptying sign in straw berry angioma- Erbs sign-seen in latent tetany. Muscular contractions can be produced by application of subthresholdelectrical stimulation.- Eye-of-the tiger appearance- is a MRI finding in Hallevorden-Spatz disease- Ewarts sign- (Pins 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 pericardialeffusion.- Ewing sign- pericardial sign



(F)- Fagets 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 fromthe 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 obliteratethat border on the chest X ray.- Fistula sign- Pressure changes can be transmitted to the membranous labyrinth if there is a fistula inthe 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 thepigmentation of the hair will be normal. Hence the hair will be alternately normally pigmented andhypopigmented, giving the appearance of a flag- Flank stripe sign- or McCort sign-in ascites. Increased distance (>2 cm) between the properitoneal fatstripe 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 closureof 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 indicatesperforation and needs surgical treatment.(Pneumoperitoneum)- Forscheimer sign- Enanthem in rubella.- Foresters sign-In hypotonic or Atonic cerebral palsy, when the child is lifted by holding at the axilla,there will be flexion at the hips.- Fredericks sign-Increased jugular venous pulse with sharp diastolic collapse. rapid Ydescent inpericardial effusion.- Froments sign-in ulnar nerve paresis , Ask the patient to grasp a book firmly between the thumb andthe other fingers .In normal persons the thumb will be straight while holding the book . In patients withulnar nerve palsy the terminal phalanx of the thumb will be flexed.- Frostbergs 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 onthe affected side when the child lies prone with hip flexed and knee flexed..- Gerhardt's sign - Pulsations over the spleen in aortic regurgitation.- Goodells 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 ofeither of the 2nd or 4th toe.- Gowers sign- is seen in Duchenne muscular dystrophy ,.It will be evident by 3 years of age and will befully expressed by 5-6 years of age. Climbing upon his own body while getting up from sitting posture.- Grassets sign in hemiplegia .When a patient with hemiplegia walk on heels, there will be abnormalmovements of the hands on the same side of hemiparesis. The arms will come slightly in front, withelbow bent and not taking part in co movements. There will be inability to keep the fingers stretched andtogether.- Grey Turners sign-A bluish discoloration seen in the flanks in patients with acute hemorrhagicpancreatitis.- Griesingers sign- is seen in lateral sinus thrombosis. The thrombus may extend and result in induratedtender 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, whichelevates fat layers beneath the skin to produce a halo sign. The so-called Buddha position is alsoindicative of hydrops fetalis- Halo sign in breast tumour - a narrow radiolucent ring surrounding a benign breat lesion.- Hammans crunch sign -crackling ,bubbling, crunching and churning sounds heard over theprecordium in pneumomediastinum..It is better heard during the systole in left lateral position inexpiration.- Head drop sign - The patient is asked to lie down. The shoulders are raised off the bed. Usually thehead also will raise but in this case the head lag will occur. Children with poliomyelitis are unable to liftthe 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 -12weeks of gestation.- Hertoghes sign- Loss of lateral third of eyebrow in atopic dermatitis- Hicks sign-is seen in pregnancy. There is light, painless irregular uterine contractions which increase infrequency and intensity as the pregnancy advances.- Higoumenakis 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 ofthe upper limb .Normally this pressure difference will be less than 20 mm of Hg. The severity of the aorticregurgitation 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- Hoffmans sign is significant of pyramidal lesion. The terminal phalanx of middle finger to be graspedby 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.- Homans 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.- Hoovers sign is seen in pleural effusion .There will be decreased chest movements on the affectedside in pleural effusion.- Hoovers sign(for unilateral weakness or paralysis of one leg )- is done to differentiate between paralysis and Pseudoparalysis of one leg .The examiners hand is placed under the heel of the paralysedleg .Now ask the patient to raise the normal leg against resistance .In normal individuals the examiner canfeel the pressure by the normal leg ..This will be absent if the leg is weak or paralysed.- Hutchinsons sign- In Herpes Zoster ophthalmicus, when the tip of the nose is involved ,the eye alsowill, 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)- Jacquemiers sign-(Chadwicks sign) bluish discoloration of the vagina will be seen by about 4-8weeks of pregnancy.- Jellinek sign- Hyperpigmented lid in hyperthyroidism



- Joffroys sign-Absence of wrinkling on the forehead on looking upwards in thyrotoxocisis.(K)- Kanavels sign- In infection of ulnar bursa ,there will be tenderness over the part of the ulnar bursalying in between the transverse palmar creases.- Kehrs sign-pain referred to the left shoulder in rupture of spleen .The pain is due to the contact ofblood in the under surface of diaphragm .The pain is mediated through the afferent fibres of the Phrenicnerve.- Kernigs sign-The patient lies supine .The hip is flexed and the knee is extended passively. In patientswith meningitis there will be pain and spasm of hamstrings.It is positive in meningeal irritation and sub arachnoid haemorrhage. It is relatively less important ininfancy and early childhood as it may be negative in spite of meningeal involvement. However, it is avery useful sign in older children.- Kestenbaums sign- is seen in optic atrophy. The number of capillaries that cross the disc margin isreduced 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 patientswith 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 childcannot kiss the knee without bending the knee.- Kochers sign-Frightened, staring look in Thyrotoxicosis.- Knuckle sign- is seen in vessel occlusion due to thrombosis .there is an abrupt tapering of the vesseldistal to the occlusion.- Kritchleys sign (Cortical thumb) in pyramidal tract lesion.- Kussmauls sign- Inspiratory prominence of jugular veins in pericardial effusion, constrictivepericarditis, restrictive cardiomyopathy..(L)- Ladins sign-is seen in pregnancy. There is softening of the medial anterior surface of the body of uterusjust 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 thepatient 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.- Leris sign- is seen in hemiplegia. There will be absence of normal flexion of the elbow on passiveflexion 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 ofkeratosis.- Lhermittes sign- electric shock like sensation radiates down the trunk ,when the trunk is flexed .itindicates cervical cord lesion ,cervical spondylotic myelopathy, sub acute combined degeneration of thecord, 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 lightintermittently.- Littens sign- in diaphragmatic palsy .There is absence of indrawing of subcostal margin duringinspiration.- Ludloffs sign is seen in avulsion fracture of the lesser trochanter. There will be inability to flex thestretched leg, when the patient is seated.(M)



- Macewens sign (Crack pot resonance) - a cracked-pot sound on percussion of the skull, may bepresent with hydrocephalus, increased intracranial pressure and sutural separation. It is due to separationof sutures in a child having increased intracranial tension. It is also simulated in many normal infants. Toelicit this sign the childs head should be lifted up from the bed and supported by putting the examinershand under the neck In children who can sit up this can be done in the sitting position. A sharp tap withthe middle finger is given on the parietal region on each side.- Macewens sign (in pericardial effusion )- Macewens sign (alcohol poisoning ) pupillary sign.- Marcus Gunn pupil sign- is seen in the patients with asymmetric, prechiasmatic, afferent conductiondefect.- Marions sign-seen in benign prostatic enlargement.- Mathes 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 Burneys sign-In acute appendicitis; pain can be elicited at the Mcburneys point by pressing with afinger- McEwan sign- In coma the pupil is constricted and dilates on painful stimuli.- McMurrays sign-In meniscus injury a painful click can be demonstrated if the flexed tibia is rotatedupon the femur.- Melting sign- In pulmonary embolism with infarction .The consolidation regresses from periphery tothe centre.- Mercedes Benz sign (Seagull sign) When gas is present in the gall stones, a characteristic dark shapewill be seen in the X ray- Milians ear sign- Erysipelas can spread in to the pinna (cellulitis cannot spread as there is no areolartissue )- Milk maid sign-Ask the patient to hold the examiner's hand,(index and middle fingers can be placedtogether).Feel for the uniformity in the force of contraction by the patient. Ask the patient to hold thefingers of opposite hand and compare with the other side. In the affected side there will be alternatingforces (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 toaspergillus 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 bariumand mucosal thickening.- Moynihams sign- is acute cholecystitis.- Muller's sign - Pulsations seen in the uvula, in aortic regurgitation.- Munsons sign- is seen in keratoconus. There will be bulging of the lower eye lid when the patient looksdown.- Murphys Sign: Ask the patient to breathe in deeply and palpate for gall bladder. At the height ofinspiration the breath is arrested with a gasp as the mass is felt. This is the sign of acute cholecystitis.(N)- Naffzigers sign-Stand behind the patient and look vertically downwards in the plane of super ciliaryridges .The eye balls can be seen protruding out of this plane if proptosis is present.- Napkin ring sign-Annular carcinoma of colon.- Nashes sign- Increased pulmonary blood flow in moderate and severe VSD.- Naunyns sign-See Murphys sign- Nicoladonis sign- see -Branhams sign- Nicolskys sign-Separation of the epidermis on giving pressure over the skin. Pemphigus vulgaris, TEN



Toxic Epidermal necrolysis, porphyria, Stevenson Johnsons syndrome, Staphylococcal scaldedsyndrome.(O)- Oil drop sign- In psoriasis .there is discolouration of nail bed.- Ollendorf sign- is seen in secondary syphilis. The papule is tender .- Ollivers 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 tractioncan be felt on the trachea. This is known as tracheal tug.- Oppenheims sign Heavy pressure is applied by the thumb and index finger from above downwardsover the anterior surface of tibia (to its medial side). The extensor response usually occurs towards theend of the stimulation.- Ortolanis sign-Ortalanis sign of jerk is the earliest sign of congenital dislocation of hip. By holding thelimbs with the hip and knees flexed ,abduct the hip joint.Placea finger over the greater trochanter.A clickcan be felt as the femoral head slips in to the acetabulum.- Osianders sign will be seen in pregnancy due to -increased vaginal pulsations- Oslers sign- Alkaptonuria(P )- Panda sign- bilateral periorbital haematoma in a patient with a fracture of the anterior cranial fossa.- Pardees sign- It is an electrocardiogram finding in myocardial infarction. A few hours after theinfarction there will be a Q wave and S-T segment is elevated.- Pastias 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 thefemur. ,when it is pressed firmly and quickly.- Pedestal sign- is seen in cementless total hip arthroplasty, when there is prosthetic loosening of thefemoral stem- Pelkens sign- is seen in scurvy. Thickened zone of provisional calcification protruding beyond theborder of the shaft.- Pen Britton sign-In retrosternal thyroid, on lifting the upper limbs ,the face is suffused, due to thepressure by the thyroid on the SVC- Penetrating sign-A radiological finding in benign gastric ulcer. The ulcer crater should project from thecontrast filled lumen and erode in to the stomach wall rather than in to the mass in the stomach wall.- Phalens 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..- Phelps sign is seen in Glomus jugulare.- Pipe stem sign- is seen in Ulcerative colitis.- Pillow sign- hairs on the pillow on getting up in nethertons syndrome.- Platysma sign of Babinski- Loss of contraction on eversion of lower eyelid or retraction of angles ofmouth..- Prayer sign-Is seen in diabetes. It is due to limited joint mobility (Cheiroarthropathy) There is inabilityto extend, the interphalangeal joint to 180 degree or limited joint mobility of interphalangeal joints of atleast one finger bilaterally.- Prehns sign- is seen in epididymo -orchitis .On elevation of the testis the pain increases in torsion andin epididymo-orchitis the pain decreases.- Pronator sign-Ask the child to hold the hands above the head with the palm facing each other for sometime. 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 thefollowing conditions 1) Voluntary withdrawal 2) In plantar hyperaesthesia 3) Strong or painful stimulus, 4) In extrapyramidal lesions- Pseudo Darrier sign- Congenital smooth muscle hamartoma- Puddles sign -To diagnose minimal ascites. The patient is put in knee chest position .Percuss theabdomen 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 theupper 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.- Reissers sign-iliac apophysis fuses with the iliac bone at maturity .This indicates a completion ofgrowth. 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 thekidney. This is due to the contrast medium circulating in the capillaries compressed by the dilated calyces.- Roberts sign- appearance of gas shadow in the heart and great vessels by 12 hours of fetal death

- Romanas sign- in Chagas disease ,.there will be unilateral painless oedema of the periorbital tissues .itis due to infection through the conjunctiva.- Rombergs 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 eyesopened and closed. If Rombergs sign is present as soon as the patient closes his eye, he begins to sway ormay even fall, It signifies sensory ataxia.- Rope sign- due to constriction of hypopharynx in poliomyelitis. There is acute angulation between thechin and larynx due to weakness of the Hyoid muscles.- Rosenbachs sign - Pulsations of the liver in aortic regurgitation.- Rossolimos Sign- Plantar surface of the Great toe is tapped with a hammer or flick the distal phalangesof the toes into extension and then allow them to fall back to their normal position. In pyramidal tractlesions, there will be plantar flexion of all the other toes including the Great toe. (This is equivalent ofHoffmans sign of the upper limbs)- Rotchs sign- Flat note in the cardio hepatic angle on the right side in pericardial effusion .- Rovsings sign-In appendicitis, when the abdomen is pressed on the left iliac region ,there will be painin 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.- Schamroths sign .This is seen in clubbing .Normally when the thumbs are placed in closeapproximation to each other so that the nails are facing each other a quadrangular space can be seen inbetween the thumbs. In clubbing (Grade II or more) of the fingers this space will be obliterated. This iscalled Shamroth sign.



- Scarf sign- The elbow crosses the midline when the arm is crossed across the chest .Keep the head inthe 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(Flamingos tint)- Scimitar sign- Crescentic shadow (Curved Turkish sword shaped shadow) of vascular density along theright border of the cardiac silhouette. This is due to anomalous pulmonary vein draining in to the inferiorvena cava.- Scottish dog sign- is seen in spondylolysis. The defect is in the pars interarticularis.. It appears like ascottish 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 fullwith hip extended ,but will be grossly restricted with the hip flexed.- Seidels sign- Sickle shaped extension of the blind spot above or below ,or both ,with the concavity ofthe 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 limbuswill not be visible. In hydrocephalus , eyes deviate downward because of the impingement of the dilatedsuprarenal recess on the tectum. .In normal new born babies this may be visible transiently. In kernicterusand 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 antrumin patients with Hypertrophic pyloric stenosis.- Shrug sign is seen in patello-femoral osteoarthritis.There will be pain ,when the patella is compressedmanually 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 aneurological examination that is abnormal for a particular age. These are present in normal children atsome stage of their development like .repetitive and successive finger movements, foot taps, hopping,tandem walking.- Spaldings sign- This is a radiological feature of intrauterine death overlapping of the skull bones at thesutural lines and shrinkage of the skull contents in fetal death.- Spatula sign- In tetanus, spasm of the child will be aggravated, when the childs mouth is pressed with aspatula.- Spooning sign is seen in chorea. Ask the patient to stretch the arms forward and hold them parallel tothe floor with the palms facing each other. The affected arm will be flexed at the wrist and extended at themetacarpophalangeal joints.This resembles a dinner fork.( Dinner fork deformity)- Steeple sign in croup.- Steinberg sign- ( Thumb sign) -In Marfans syndrome ,Protrusion of the thumb beyond the ulnarborder 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 trappedbetween 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.-Crohns disease is due to the marked narrowing of theaffected bowel.- Sulcus sign a radiological sign in inferior dislocation of shoulder ,where the head of the humerus liesbelow 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 overthe back.. The pulsations are prominent over the scapula and is best visualized with the patient bendingforwards.(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- Thinkers sign- due to the abnormal posture of the patient in COPD.- Thumb sign-See Steinberg sign. It is seen in Marfans syndrome.- Thurston-Holland sign -Intra articular fracture ,the line going through the plate and through the partof the metaphysis.- Tinels sign-When a regenerating nerve is tapped at the level of regeneration there will be a tinglingsensation- Tragers sign This is a sign of fetal death in utero. The fetal attitude in a X-ray will be with marked curvature orcollapse 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 theposition of the pelvis. If the test is negative the pelvis will be raised on the unsupported side .If the test ispositive the pelvis will drop on the unsupported side.- Trethowans sign- is positive in slipped femoral epiphysis. Normally the line drawn along the superiorsurface of the neck passes bisecting the head of femur. In this condition this line` passes superior to thehead.- Triple bubble sign- Jejunal atresia.- Tripod sign is seen in poliomyelitis. The child sits with the knees flexed and both the hands placedbehind him supporting on the back as if in the tripod position. On stretching the legs the meninges arestretched which aggravates the pain. By assuming the tripod position the stretching of the meninges isavoided thereby the pain is reduced.- Troisiers sign enlarged left supraclavicular node (Virchows node)due the gastric malignancy.- Trolley track sign -Signs in Ankylosing spondylitis Three vertical linerar lines with increased densitywill be seen.- Trousseaus sign-Phlebo thrombosis of superficial veins.- Trousseau's sign-Ischemia of the upper limb is caused by inflating a sphygmomanometer cuff above thearterial 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.- Throgmortons sign-Extension of the suspensory ligament of the penis prior to micturition in newborninfants.( 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 inScarpas triangle.- Verumonten sign- is seen in complete rupture of urethra. The prostate will be floating in per rectalexamination.- Von Graefes sign- in Thyrotoxicosis. Lag of the upper lid on downward gaze.- Von Rosens sign (Barlows sign ) In congenital instability of the hip joint the hips are held flexedand abducted , A click can be heard when the femoral head leaves the acetabulum .- Victor Horsleys 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 theexaminers flexed fingers. A pull in the opposite direction should be applied , so that the fingers of eachother pull against other's resistance. Normally the thumb extends. In the presence of cortical lesions thethumb adducts and flexes.- Wimbergers signX-ray knee bilateral erosion in upper medial end of tibia. It will be seen incongenital syphilis ,scurvy .- Winter bottom sign- is seen in Trypanosoma brucei infection African trypanosomiasis (Sleepingsickness).The regional nodes enlarge in the posterior cervical triangle..- Wredens sign- is seen in a stillborn baby. Gelatinous material more or less completely fills the externalauditory meatus.- Wrist sign-It is seen in Marfans syndrome. Ask the patient to grasp the wrist with the thumb and thelittle finger. There will be overlapping of the fingers.- W sitting- is seen in persistent anteversion of the femoral neck .Children sit between their feet withthe 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 (Boorhaeves syndrome)- Deep lateral femoral notch sign- Tibia vara due to retarded growth of medial half of the proximal

tibial epiphysis (Blounts disease)- Vital signs- pulse, respiration, temperature.

RADIOLOGICAL SIGNSCoffee bean sign (Birds 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 itTriple bubble sign- Jejunal atresiaFloating 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 causesa rapid filling of the peripheral blood vessels and rapid emptying of these vessels. This is the cause forthe peripheral signs of the aortic regurgitation.

a) Demusset signb) 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 Bachs 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 Ds Duroziez's murmur. Diastolic murmur, Diaphragm, Distal compression.)

3) Signs in appendicitis a) Aarons sign b) Bastedos sign c) Rovsing s sign d) Dieulafoys triad

- e) Blumbergs sign f) Coopers 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 fatstripe and the right colon. Hellmen sign- Radiolucent shadow between the lateral wall of liver and the abdominal wall. Dogs ear sign-Radiodensity superior and lateral to the bladder5) Signs in ASOM- - Light house sign - Nipple sign6) Signs in ATRIAL SEPTAL DEFECT -

- Jug-handle appearance in ASD , (dilated right atrium, ventricle, and pulmonary arteries withless 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 beassociated 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 inrecumbent patients.2) CARDIOMYOPATHYSigns of restrictive cardiomyopathy are Edema, Ascites, Enlarged pulsatile liver Increased JVP Kussumauls 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 footplaced near the tip of the toes of the other leg .This will be abnormal in patients with cerebellar lesionsand posterior column lesions. Romberg test. The patient is asked to stand straight with both the feet close to each other .Firstthe patient is asked to stand with the eyes open and then with the eyes closed. In cases with posteriorcolumn lesions where the position sensation is lost, the patient will fall on the side of the lesion when theeyes are closed. This is because the patient adapts to the loss of position sensation by the visualassessment of the positions. When the eyes are closed or in the dark this adaptation will be lost and thepatient tends to fall down4) SIGNS IN ACUTE CHOLECYSTITIS Cystic duct sign Rim sign5) 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 iselicited. The extension at the knee joint will be maintained for some time before the leg comes down. Thisis called hung up reflex and occurs in the affected side. f) Spooning sign- g) Emotional lability h) Czernys sign6) SIGNS IN CIRRHOSIS LIVER

- Dawsons sign - Terry nails (leuconychia ) white nails seen in thumb and index fingers .

- Dupuytrens contracture- Clubbing- Spider angiomata

7) SIGNS IN COARCTATION OF AORTA- - Docks sign - Suzmans sign8) 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 ReflexCORTICAL 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 humeruslies below the glenoid.(E)1) SUB ACUTE BACTERIAL ENDOCARDITIS

Anemia Clubbing- -acute, Tender Oslers nodes- Painful, Pea sized intradermal nodes In the Pads of fingers and toes Janeway lesions-painless, small erythematous, hemorrhagic lesionsin 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 theabducent nerve.2) Signs of Avascular necrosis of femoral head a) Positive Trendelenberg s sign b) Sectoral sign3) Signs of fetal death-

- Roberts sign- Spalding sign- Balls sign- Duels or halos sign

- Trager sign4) Signs of fracture

a) Crepitusb) Deformityc) Local bony tendernessd) Abnormal mobilitye) Shortening of a segment of limb

5) Basilar skull fractureFour classical signs of basilar skull fracture a) Racoon eyes- Periorbital ecchymosis in anterior basilar fracture. b) Battles sign c) Hemotympanum (Fracture of the petrous ridge ) d) CSF otorrhoea /Rhinorrhea. (Fracture cribrifirm plate )(G)SIGNS IN GASTRIC ULCER- a) Carmans sign- is seen in malignant gastric ulcer. Meniscus shaped gastric ulcer with theconcavity pointed towards the gastric lumen b) Penetrating sign-The ulcer crater should project from the contrast filled lumen and erode in tothe 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-- Trendelenburgs sign.

2) Signs of hydronephrosis- Rim sign3) SIGNS IN HYPERTROPHIC PYLORIC STENOSIS. a) Target sign

b) Tram track sign-c) String signd) Beak signe) Shoulder sign

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

5) EARLY SIGNS OF HYPOTHYROIDISM-Prolonged physiological jaundice,Hypothermia,Hypotonia,Mottled skin,

(I )1) INTUSSUSCEPTION - Signs of intussusception are

a) Claw signb) Pitch fork sign in barium enemac) oiled spring deformity

(K)1) EARLY SIGNS OF KERNICTERUS- Poor feeding Lethargy Altered cry Altered behaviour2) SIGNS OF KNEE JOINT EFFUSION a) Patellar tap sign- b) Bulge sign(L )1) Lateralizing signsIn coma it will be difficult to recognize the focal neurological signs .The following features wil indicatethe side of the lesion

a) Menace reflex (Asymmetric hemianopia)b) Facial weaknessc) Abnormal toned) Response to painful stimulie) Asymmetry in plantar responsef) Asymmetry in tendon reflexesg) 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,- Duputryens contracture- Gynaecomastia

- Caput medusa - Gastrointestinal bleeds- Haematemesis - Ascites - Oedema

- Testicular atrophy- Neurological signs- Asterixis

(M )1) SIGNS IN MARFANS SYNDROME a) Arachnodactyly-long and slender fingers and toes .

b) Steinbergs sign or thumb sign -The thumb may be adducted across the narrow palm.c) Wrist sign-

(N )1) SIGNS OF NERVE PARESIS

Ulnar nerve paresisa) Froments signb) Paper test for interosseous musclesc) 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 handdue 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 poliomyelitis3) NECROTIZING ENTEROCOLITIS Pneumatosis intestinalis Foot ball sign- if Pneumoperitoneum is present.(O)



1) OPTIC ATROPHYSigns of Optic atrophy Uthoffs phenomenon- Worsening of vision during fever in hot weather or after exercise .centralconduction is slowed by increase in the body temperature(P )1)PANCREAS SIGNS IN ACUTE HEMORRHAGIC PANCREATITIS.

a) Cullen signb) Grey turner sign

CARCINOMA HEAD OF PANCREAS a) Frostbergs inverted 3 sign b) Rose thorning of duodenum c) Scrambled egg appearance d) Double duct sign2) SIGNS IN PERICARDIAL EFFUSION

- Dresslers sign- Rotchs sign-Dullness over the right sternal border.- Friedreichs sign-Rapid y descent- Kussmauls sign- Pulsus paradoxus- Ewarts sign- Gerhards dullness- Dullness over the second left intercostal space.- Ewing sign

3) SIGNS IN PLEURAL EFFUSION- Ewarts 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) Hegars sign softening of cervix in pregnancy b) Osianders sign (Vaginal sign) increased pulsations through lateral fornices .this occurs by 8weeks of gestation. c) Goodells sign (Cervical sign) Softening of the cervix with bluish discoloration by 6 weeks of gestation d) Jacquemiers sign (Ghadwicks sign) dusky hue of the vestibule and the anterior vaginal walloccurs by 8 weeks of gestation e) Placental sign- Cyclical bleeding occurs up to 12 weeks of pregnancy. f) Braxton Hicks sign- g) Ladins 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) Pastias sign-2) Signs in scoliosis Reisser s sign-iliac apophysis fuses with the iliac bone at maturity .This indicates a completion ofgrowth. 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) SYPHILISSigns of congenital syphilis Wimberger signX-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 cuffabove 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 leadsto brief twitching of the facial muscles. c) Peroneal sign- d) Erbs sign e) Hyperventilation will precipitate latent tetany.2) THALASSEMIA Hair on end appearance in X-ray skull3) 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) Joffroys 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) Kochers sign- Frightened ,staring look.4) TUBERCULOSISSign in ileocecal tuberculosis a) Fleischner sign- Inverted umbrella defect due to a wide gap between the thickened patulousileicecal valve and narrowed ulcerated terminal ileum . b) Stierlins 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) Pratts sign-Calf tenderness on squeezing the calf from the sides. c) Homans sign-Calf tenderness on forced ankle dorsiflexion. d) Phlegmasia alba dolens-Painful white leg. e) Phlegmasia cerula dolens-Painful blue leg2) SIGNS OF VITAMIN DEFICIENCIESa) Signs of Vitamin A deficiency Bitots spots Xerosis (Corneal & conjunctival) Keratomalacia

Toad skin-Phrynodermab) Signs of Vitamin D deficiency-Rickets-Bossing of skull, Rachitic rosary, Harrison sulcus, genuvarum ,genu valgus, Genu recurvatumHot cross bun appearance of skull, widening of wrists, double malleoli, CraniotabesX ray signs in Rickets X-ray wrists - Cupping and fraying - saucer like epiphyseal endc) Signs of Vitamin K deficiency-Petechiae, purpurad) Signs of Vitamin E deficiency-Anemia (hemolytic)e) Signs of Vitamin B deficiency -

Angular stomatitis,cheilosis-PellagraBeri Beri-Thiamine, Edema-Wet beri beri, neuritis Dry Beri beriDermatitis Niacin-Casal necklaceGlossitisJerks- 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 .

KeratitisSeborrhoeic 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 toformation of spur or marginal cleft.

b) Pelkens sign-Pelken spur- due to fracture of the Metaphyseal corner.c) Wimbergers signd) 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 longbones.

e) Pseudoparalysis of parrotf) 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 sachs disease GM 2 type 1, Sandhoff variant)Niemann-Pick diseaseMetachromatic leucodystrophyMucolipidoses.

3) Tension signs in lumbar disc herniationLasegues testBow string signSitting root test

4) Babinskis sign - By stroking the lateral aspect of the dorsum of the footPositive 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 hipThe other methods of eliciting plantar extensor reflex- In pyramidal tract lesions, there is an increase in the reflexogenic area. Hence the reflex may be elicitedeven by stroking the skin high above in the leg.

a) Oppenheims 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 towardsthe end of the stimulation. b) Gordons reflex Squeezing or applying deep pressure to calf muscles or tendo-achillesproduce extensor plantar response.

c) Chadocks sign Extensor response is seen after striking the skin around the lateral malleolusin 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 distalphalanx of either of the 2nd or 4th toe. g) Brissauds reflex In patients with absent toe or amputated toe the plantar extensor responsecannot be seen by observing the great toe since such cases look for the contraction of the tensor fascialata.PSEUDO-BABINSKI'S SIGN The plantar extensor response may be seen in the absence of pyramidal tract lesions inn thefollowing conditions 1) Voluntary withdrawal 2) In plantar hyperaesthesia 3) Strong or painful stimulus, 4) In extrapyramidal lesions5) Release reflexesa) Hoffmans 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 andflexion of the thumb and flexion of the other fingers signifies pyramidal lesion.b) Rossolimos Sign-Plantar surface of the Great toe is tapped with a hammer or flick the distal phalangesof the toes into extension and then allow them to fall back to their normal position. In pyramidal tractlesions, there will be plantar flexion of all the other toes including the Great toe. (This is equivalent ofHoffmans sign of the upper limbs)



X-RAY SIGNSThe 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 fungalball aspergilloma )- Bare area sign- is seen in pleural effusion .The peritoneal ligament prevents ascitic fluid fromextending over the entire posterior surface of the liver, where as in pleural space, the pleural fluid mayextend over the entire posterior costophrenic recess behind the liver.- Double bubble sign- Duodenal atresia- Double decidual sign-in normal intrauterine pregnancy- Goldens sign-hilar mass with collapse.- Hoffman Riglers sign-to assess the left ventricular enlargement in a lateral film . ?he distance fromthe posterior aspect of the inferior vena cava to the posterior border of the heart horizontally at a level 2cm 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 beless sharp than that of between the liver spleen and ascites.- Nicoladonis or Branhams sign- in proximal AV fistula.- pencil in cup deformity -Psoriatic arthritis-X ray shows pencil in cup deformity of distal interphalangeal joints.- Rail road calcification- Struge Weber syndrome- Westermarks 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- Frostbergs inverted 3 sign- in carcinoma head of pancreasERCP- Double duct sign in carcinoma head of pancreas.BARIUM ENEMA-

- Claw sign (Pitch fork sign) in intussusception.FIRST SIGNS1) First sign of puberty in males Testicular growth EARLIEST SIGNSa) Earliest radiological sign of rickets is widening of epiphysisb) Earliest clinical sign of rickets in 6 months old child is Craniotabes.c) Earliest clinical sign of Volkman ischemic contracture Passive stretch pain.- Ortalanis 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 areliable 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 SIGNOsteomyelitis-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

Documents

antenna sign

balls sign

rosens sign

auspitzs sign

ballance sign

aarons sign

adlers sign

allis sign