SIGNS IN MEDICINE---IMP LIST
(A)- Aarons sign seen in appendicitis. On firm pressure over the
McBurneys pointthe patient with appendicitis will feel distress in
the epigastrium orprecordial region.
- Abadiesign - This is the test of Muscle sense .Compress or
squeeze bigmuscle bellies (calf,` triceps or biceps)and note
whether the patient complainsof 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 is turned from side to
side.
- Albright sign-Metacarpels are shortened in
pseudohypoparathyroidism , nevoidbasal cell carcinoma ,turner and
Larsen .In the presence of short fourthmetacarpal ,there will be a
dimple at the metacarpophalangeal joint.
- Alfred Demusset sign- Bobbing of the head with each heart
beat. The rapidblood flow in the carotids will push the head with
each beat, thus leading tomovement 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 beflexed at a right angle and the upper
part of the tibia is pulled forward andpushed 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 bleedingspots will be seen .(B)
- Babinskis sign- By stroking the lateral aspect of the dorsum
of the foot.There is contraction of tibialis anterior, 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 there will be shift of the
dullness ,but it is constant onthe left side.
- Ballentyne-Runge sign - Decrease in the abdominal
circumference late inpregnancy due to placental insufficiency
- Banana sign the frontal lobes will be concave .This is due to
neural tubedefects
- Barbers chair sign in multiple sclerosis. An electric shock
like sensationwhich radiates in to the arms., down the back to the
legs, when the patientflexes the head..
- .Barlows sign- Von Rosens sign In congenital instability of
the hip jointthe hips are held flexed and abducted , A click can be
heard when the femoralhead leaves the acetabulum
- Bastedos sign seen in chronic appendicitis. On inflation of
the colon withair ,pain and tenderness will be present in the right
iliac fossa.
- Battles sign-blood pigment stain behind the ear over the
mastoid due tobasal skull fracture (Sphenoid bone )
- Beak sign - in patients with Hypertrophic pyloric stenosis.
,abrupt cut of thebarium column in the pylorus.
- 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 umbilicuswill move downwards in paralysis of
upper part of rectus abdominis
- Beheaded scottish terrior sign- Spondylolisthesis.(In oblique
view)
- Belly dancers sign- It is seen in unilateral diaphragmatic
paralysis .Duringinspiration the umbilicus shifts upward and toward
the side of the paralyseddiaphragm
- Bendas sign- This is of importance in tuberculous meningitis.
Here the childhas spasm of the trapezius muscle with the result
that the shoulder on affectedside is raised up and at times also
brought forward. The sign is elicited byturning the head and chin
to one side and if there is upward and forward liftingof 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 uppereyelid. It is the earliest sign of facial nerve
paralysis.
-Bergman sign (Chalice sign)-is a finding in renal imaging
studies where thereis dilatation of ureter distal to a neoplasm.
Such dilatation will beabsent 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 .Therewill be raised purple skin lesions.
- Blue dot sign-is seen in torsion of appendix testis .The
appendix that hasundergone torsion may be visible through the
scrotal skin.
- Blumbergs sign Rebound tenderness. It is seen in acute
appendicitis.
- Boas sign- is helpful in differentiating acute cholecystitis
from otherconditions. In acute cholecystitis there is a referred
pain to the rightscapula. There is an area of hyperaesthesia
between the ninth and the eleventhribs posteriorly on the right
side..
- Bows sign-Seen in septicemia in infants. The right side of the
mediastinalshadow resembles a bow.
- Bow string sign-is used in lumbar disc herniation. It is a
variation ofstraight leg raising test. When the leg is raised pain
will occur. At the pointof pain, the knee will be flexed which will
reduce the pain.
- Branhams sign- (see Nicoladonis sign) is seen in aretrio
venous fistula .Theswelling due to arteriovenous fistula disappears
on applying pressure on theartery proximal to the fistula, thrill
and bruit will decrease and the pulserate fall .the pulse pressure
will return to normal.
- Brim sign- is seen in Pagets disease.
- Braxton Hicks sign-Intermittent uterine contractions can be
detected bypalpation after 16 weeks of gestation in pregnancy.
- Brudzinskis sign is seen in meningitisFlexion of one lower
limb causes flexion of opposite limb immediately. It isthe 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 the neck, the child
flexes both his lower limbs, at thehips as well as knees. This is a
common sign of meningitis in infancy. Theremay be minimum flexion
of the lower limbs when the child has paraplegia orquadriplegia;
there is unilateral flexion of the unaffected limb. This not
onlyhelps in the diagnosis of meningitis but also in the diagnosis
of hemi paresis.Brudzinskis leg sign- Here one of the lower limbs
is flexed to 45 at the hipand 90-120 at knee. While trying to
extend the lower limbs there is flexion ofthe opposite limb at the
hip and knee. This is a positive Brudzinskis legsign. In children
who are constantly moving the lower limbs, particularly inthe first
2-3 years of life, the test should be carried out 3 to 4 times
beforeit is concluded as positive. If a child has weakness or
paralysis of theopposite limb there may be minimum flexion at the
hip and knee.)
- Bruns sign- Excruciating headache , vertiginous episodes ,
coma and deathdue to sudden movement of the head ,if the cysts are
present in the fourthventricle .
- Bryants sign-in shoulder dislocation .Abnormal position of
axillary folds.
- Bulge sign- Small effusion in the knee joint. Apply gentle
pressure first onthe medial side of the joint when the patient is
lying with the quadricepsrelaxed. 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
posterioracetabular margin will cut across the medial corner of the
metaphysis. In thiscondition the entire metaphysis will remain
lateral to the posterior acetabularmargin.
- Cardarellis sign- transverse pulsation in the laryngotracheal
tube inaneurysms and dilatation of the aortic arch.
- Carmans Meniscus sign- A radiological finding seen in
malignant gastriculcer. Meniscus shaped gastric ulcer with the
concavity pointed towards thegastric lumen
- Carpet tacks sign- is seen in Discoid Lupus Erythematosis
(DLE)
- Carvallos sign- In cases with ASD, the tricuspid murmur is
maximal at thelower sternal edge and increases in intensity during
inspiration
- Cerebriform tongue sign-is seen in Pemphigus vegetans
- Chaddocks sign seen in pyramidal tract lesion. Extensor
response is seenafter striking the skin around 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 inachondroplasia.
- Chvosteks sign -The facial nerve is tapped at its exit from
the stylomastoidforamen. This leads to brief twitching of the
facial muscles, ala of the noseand the blinking of the eyelids.
.Elevation of the corner of mouth may b e seen.
- Coffee bean sign- Strangulation of incompletely obstructed
loop of smallbowel.
- Coin test-is found in tense Pneumothorax. Place a metallic
coin on the upperpart of the affected chest, and percuss over the
coin with another coin. Listenat the same time from the back with
the diaphragm of a stethoscope. A highpitched 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 ofmandible.
- Combys sign-is seen in measles. In early stages thin whitish
patches are seenon the gums and buccal mucous membranes.
- Commandos sign-in spastic cerebral palsy the child drags the
feet like arudder.
- Coopers sign- In acute appendicitis, the tenderness is
elicited in the leftlateral position.
- Corners sign- seen in scurvy. A groove will be present just
above the zone ofprovisional calcification.
- Corrigan's sign - Dancing carotids in aortic
regurgitation..
- Counting sign-in diaphragmatic paralysis ,the patient cannot
count more than10 in one breath.
- Coupdongue sign- Tinea versicolor.
- Courvoisier sign- Gall bladder will be palpable in patients
with carcinomahead 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 thecollecting ducts compressed by the dilated
calyces.
- Crowes sign In neurofibromatosis , axillary freckling and
speckledhyperpigmentation over the upper chest ,groin and perineal
region will bepresent .
- Cruveilhier s sign-is seen in portal hypertension. Caput
medusa due toportocaval anastomosis.
- Cullen sign-A bluish discoloration seen around the umbilicus
in patients withacute hemorrhagic pancreatitis.
- Curtsy sign is seen in Sham or Urge syndrome
- Czernys 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 linewill be seen.
- Dance sign- in intussusception. The right lower quadrant may
feel empty topalpation in intussusception.
- Darier sign- Urticaria pigmentosa. The lesions tend to become
red, itchy andurticarial if they are rubbed.
- Dalrymple sign-(Lid retraction) Staring appearance due to
abnormal wideningof palpebral fissures in hyperthyroidism
- Dawbarns sign- seen in subacromial bursitis .The pain in this
condition willdisappear on abduction of the arm.
- Dawsons sign-Palmar erythema in cirrhosis of liver
- De Dance sign-The Signe de Dance A feeling of emptiness in the
right iliacfossa in acute intussusception.
- D Espines sign-A large mediastinal node or a mass in
Bronchogenic carcinomamay transmit the tracheal sound .This can
result in bronchial breath sound,whispering pectoriloquy and rarely
egophony in the inter scapular region.(BelowD4)
- 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 zoneof reduced density visible around the head of
relatively mature fetus beforedelivery appears to be separated from
the cranium .The density of this zone willbe 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
Dermatofibrosarcomaprotuberans.
- 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 conditionsDuodenal
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
pericardialeffusion.
- 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 beable to put the hand to the opposite shoulder with the
elbow close to the body.
- Duroziezs sign- diastolic murmur heard on the femoral artery
on distalcompression.(E)
- Emptying sign in straw berry angioma
- Erbs sign-seen in latent tetany. Muscular contractions can be
produced byapplication of subthreshold electrical 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 basalsegments due to large pericardial effusion.. There will be
dullness onpercussion, increased vocal resonance, tubular breath
sounds., increased vocalresonance. and bronchial breathing are seen
in cardiac tamponade due to pericardial effusion.
- Ewing sign- pericardial sign(F)
- Fagets sign- is seen in yellow fever. Relative bradycardia is
present fromthe second day of the illness.
- Falling fragment sign-Solitary bone cyst.
- Fat pad sign-is seen in pericardial effusion .In normal
persons the parietalpericardium is separated from the epicardial
fat by about 1-2 mm. This isincreased in pericardial effusion.
- Felson s silhouette sign- any intrathoracic mass touching the
heart ,aorta ordiaphragm will obliterate that border on the chest X
ray.
- Fistula sign- Pressure changes can be transmitted to the
membranouslabyrinth if there is a fistula in the bony labyrinth.
Pressing the tragus willinduce jerk nystagmus.
- Fitzpatrick sign-in dermatofibroma .There will be dimpling
when the mass issqueezed on both sides.
- Flag sign- Flag sign may be seen in Kwashiorkor. The hair will
be alternatelynormal and depigmented. The hair in cases of severe
malnutrition will behypopigmented. As the nutrition improves the
pigmentation of the hair will benormal. 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 thefalciform ligament indicates perforation and needs
surgicaltreatment.(Pneumoperitoneum)
- Forscheimer sign- Enanthem in rubella.
- Foresters sign-In hypotonic or Atonic cerebral palsy, when the
child islifted by holding at the axilla ,there will be flexion at
the hips.
- Fredericks sign-Increased jugular venous pulse with sharp
diastolic collapse.rapid Ydescent in pericardial effusion.
- Froments 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 willbe straight while holding the book .
In patients with ulnar nerve palsy theterminal 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 willbe lowering of the knee on the affected side when
the child lies prone with hipflexed 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 orsnapping of distal phalanx of either of the 2nd or 4th
toe.
- Gowers sign- is seen in Duchenne muscular dystrophy ,.It will
be evident by 3years of age and will be fully expressed by 5-6
years of age. Climbing upon hisown body while getting up from
sitting posture.
- Grassets 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 comovements. There will be
inability to keep the fingers stretched and together.
- Grey Turners sign-A bluish discoloration seen in the flanks in
patients withacute hemorrhagic pancreatitis.
- Griesingers sign- is seen in lateral sinus thrombosis. The
thrombus mayextend and result in indurated tender area over the
upper part of the internaljugular vein and mastoid region.
- Groove sign- Lymphogranuloma venereum (LGV) The enlarged lymph
nodes are seenboth above and below the inguinal ligament.(H)
-Halo sign.- Severe erythroblastosis with hydrops fetalis is
demonstrable byextensive edema, which elevates fat layers beneath
the skin to produce a halosign. The so-called Buddha position is
also indicative of hydrops fetalis
- Halo sign in breast tumour - a narrow radiolucent ring
surrounding a benignbreat lesion.
- Hammans crunch sign -crackling ,bubbling, crunching and
churning soundsheard over the precordium in pneumomediastinum..It
is better heard during thesystole in left lateral position in
expiration.
- Head drop sign - The patient is asked to lie down. The
shoulders are raisedoff the bed. Usually the head also will raise
but in this case the head lagwill occur. Children with
poliomyelitis are unable to lift the head or bring italong 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; ofliver and the abdominal wall.
- Hegar s sign-Softening of the isthmus or the lower segment of
the uterus Thiscan be seen at 6 -12 weeks of gestation.
- Hertoghes sign- Loss of lateral third of eyebrow in atopic
dermatitis- Hicks sign-is seen in pregnancy. There is light,
painless irregular uterinecontractions which increase in frequency
and intensity as the pregnancyadvances.
- Higoumenakis sign-Enlargement of the medial end of the
clavicle which is alate feature of syphilis.
- Hill's sign-is seen in Aortic Regurgitation .The systolic
pressure in thelower limb is more than that of the upper limb
.Normally this pressuredifference 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 160degrees- Hoffmans sign is significant of pyramidal
lesion. The terminal phalanx of
middle finger to be grasped by the examiner. The hand to be
pronated. Sharpflickering movement of terminal phalanx will produce
adduction and flexion ofthe 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 fingerwith pain on extension.
- Hoovers sign is seen in pleural effusion .There will be
decreased chestmovements on the affected side in pleural
effusion.
- Hoovers sign(for unilateral weakness or paralysis of one leg
)- is done todifferentiate between paralysis and Pseudoparalysis of
one leg .The examinershand is placed under the heel of the
paralysed leg .Now ask the patient to raisethe normal leg against
resistance .In normal individuals the examiner can feelthe pressure
by the normal leg ..This will be absent if the leg is weak
orparalysed.
- Hutchinsons sign- In Herpes Zoster ophthalmicus, when the tip
of the nose isinvolved ,the eye also will, be involved. This is
because both the area aresupplied 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 willbe seen by about 4-8 weeks of pregnancy.
- Jellinek sign- Hyperpigmented lid in hyperthyroidism
- Joffroys sign-Absence of wrinkling on the forehead on looking
upwards inthyrotoxocisis.(K)
- Kanavels sign- In infection of ulnar bursa ,there will be
tenderness overthe part of the ulnar bursa lying in between the
transverse palmar creases.
- Kehrs sign-pain referred to the left shoulder in rupture of
spleen .The painis due to the contact of blood in the under surface
of diaphragm .The pain ismediated through the afferent fibres of
the Phrenic nerve.
- Kernigs sign-The patient lies supine .The hip is flexed and
the knee isextended passively. In patients with meningitis there
will be pain and spasm ofhamstrings.It is positive in meningeal
irritation and sub arachnoid haemorrhage. It isrelatively less
important in infancy and early childhood as it may be negativein
spite of meningeal involvement. However, it is a very useful sign
in olderchildren.
- Kestenbaums sign- is seen in optic atrophy. The number of
capillaries thatcross 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 andthe index finger In patients with anterior
interosseous syndrome, fine pinchposture is abnormal.
- Kiss the-knee sign- Ask the child to sit and kiss the knee. In
the presenceof Nuchal rigidity, the child cannot 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 anabrupt tapering of the vessel distal to the
occlusion.
- Kritchleys sign (Cortical thumb) in pyramidal tract
lesion.
- Kussmauls sign- Inspiratory prominence of jugular veins in
pericardialeffusion, constrictive pericarditis, restrictive
cardiomyopathy..(L)
- Ladins sign-is seen in pregnancy. There is softening of the
medial anteriorsurface 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 beatsand not related to light reflex.
- Lassigue sign-A positive leg rising test .It is present in
sciatica, prolapsedintervertebral disc. With the patient lying
supine, ask him to elevate theextended leg .A normal person can
extend up to 90 degrees. The test is positiveif the movement is
restricted.
- Lemon sign- See banana sign the frontal lobes will be concave
.This is due toneural tube defects.
- Leris sign- is seen in hemiplegia. There will be absence of
normal flexion ofthe elbow on passive flexion of the hand at wrist
on the affected side.
- Leser-Trelat sign- is seen in internal malignancy. There will
be suddenappearance of large number of keratosis.
- Lhermittes sign- electric shock like sensation radiates down
the trunk ,whenthe trunk is flexed .it indicates cervical cord
lesion ,cervical spondyloticmyelopathy, sub acute combined
degeneration of the cord, radiation myelopathy
- Light house sign - alternate flushing, and blanching of the
forehead in AorticRegurgitation
- Light house sign in acute Suppurative otitis media.. a
pulsating dischargewill reflect the light intermittently.
- Littens sign- in diaphragmatic palsy .There is absence of
indrawing ofsubcostal margin during inspiration.
- Ludloffs sign is seen in avulsion fracture of the lesser
trochanter. Therewill be inability to flex the stretched leg, when
the patient is seated.(M)
- Macewens sign (Crack pot resonance) - a cracked-pot sound on
percussionof the skull, may be present with hydrocephalus,
increased intracranial pressureand sutural separation. It is due to
separation of sutures in a child havingincreased intracranial
tension. It is also simulated in many normal infants. Toelicit this
sign the childs head should be lifted up from the bed and
supportedby putting the examiners hand under the neck In children
who can sit up thiscan be done in the sitting position. A sharp tap
with the middle finger isgiven 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 conduction defect.
- Marions sign-seen in benign prostatic enlargement.
- Mathes sign-In patients with perinephric abscess, the kidney
does not descenddown in erect posture .In normal persons the kidney
will descend in erectposture .
- Maxwell-Lyons sign-is seen in vernal conjunctivitis. A
fibrinouspseudomembrane may be seen.
- Mc Burneys sign-In acute appendicitis; pain can be elicited at
the Mcburneyspoint by pressing with a finger
- 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 theflexed tibia is rotated upon the femur.
- Melting sign- In pulmonary embolism with infarction .The
consolidationregresses from periphery to the centre.
- Mercedes Benz sign (Seagull sign) When gas is present in the
gall stones, acharacteristic dark shape will be seen in the X
ray
- Milians ear sign- Erysipelas can spread in to the pinna
(cellulitis cannotspread as there is no areolar tissue )
- Milk maid sign-Ask the patient to hold the examiner's
hand,(index and middlefingers can be placed together).Feel for the
uniformity in the force ofcontraction by the patient. Ask the
patient to hold the fingers of opposite handand 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 thepulmonary 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 flexionof ankle
- Moses sign-In venous thrombosis, pain can be elicited by
squeezing the calfmuscles.
- Moulage sign-is seen in Malabsorption syndrome .It is due to
flocculation andsegmentation of barium and 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 eyelid when the patient looks down.
- Murphys Sign: Ask the patient to breathe in deeply and palpate
for gallbladder. At the height of inspiration the breath is
arrested with a gasp as themass is felt. This is the sign of acute
cholecystitis.(N)
- Naffzigers sign-Stand behind the patient and look vertically
downwards in theplane of super ciliary ridges .The eye balls can be
seen protruding out of thisplane 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, StevensonJohnsons 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 .
- Ollivers sign-Upward and down ward movement of the trachea can
be seen inpatients with COPD. The chin should be raised and upward
pressure should beapplied over the trachea. A downward traction can
be felt on the trachea. Thisis known as tracheal tug.
- Oppenheims sign Heavy pressure is applied by the thumb and
index fingerfrom above downwards over the anterior surface of tibia
(to its medial side). The extensor response usually occurs towards
the end of the stimulation.
- Ortolanis sign-Ortalanis sign of jerk is the earliest sign of
congenitaldislocation of hip. By holding the limbs with the hip and
knees flexed ,abductthe hip joint.Placea finger over the greater
trochanter.A click can be felt asthe 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 ofthe anterior cranial fossa.
- Pardees sign- It is an electrocardiogram finding in myocardial
infarction. Afew hours after the infarction there will be a Q wave
and S-T segment iselevated.
- Pastias sign-is seen in scarlet fever .Residual petechial
lesions in theantecubital fossa.
- Peroneal sign-Seen in latent tetany. Tapping the peroneal
nerve at the neck ofthe fibula will produce dorsiflexion and
abduction of the foot.(eversion offoot )
- Patellar apprehension sign-apply lateral pressure to the
patella with the kneeextended to 30 degrees .and the quadriceps
relaxed .The patient fears that thepatella may be dislocated and
extends the knee thereby relocating the patellato the normal
position.
- Patellar tap sign- is seen in knee joint effusion. The
effusion delays thepatellar tapping against the femur. ,when it is
pressed firmly and quickly.
- Pedestal sign- is seen in cementless total hip arthroplasty,
when there isprosthetic loosening of the femoral stem
- Pelkens 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 ,theface is suffused, due to the pressure by the thyroid on
the SVC
- Penetrating sign-A radiological finding in benign gastric
ulcer. The ulcercrater should project from the contrast filled
lumen and erode in to the stomachwall rather than in to the mass in
the stomach wall.
- Phalens sign-In carpel tunnel syndrome ,the signs and symptoms
will increaseon flexion of the wrist .On straightening these will
improve. This is also knownas 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 orretraction 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 to180 degree or limited joint mobility of
interphalangeal joints of at least onefinger bilaterally.
- Prehns sign- is seen in epididymo -orchitis .On elevation of
the testis thepain increases in torsion and in epididymo-orchitis
the pain decreases.
- Pronator sign-Ask the child to hold the hands above the head
with the palmfacing each other for some time. The patient will not
be able to hold it insame position. The hand on the affected side
will be pronated and the palm willface outwards
- Pseudo-babinski's sign The plantar extensor response may be
seen in the absence ofpyramidal 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
- Puddles sign -To diagnose minimal ascites. The patient is put
in knee chestposition .Percuss the abdomen towards the umbilicus to
elicit the dullness.
(Q )
- Quinke's sign (In aortic regurgitation) There will be
alternate flushing andblanching in the nail bed. (R)
- Raccoon eye sign-is seen in fracture of the base of the skull.
Bilateralecchymosis and swelling of the upper eye lids will be
present..
- Red dot sign-Abdominal wall is discolored with focal or
diffuse erythemareflects underlying peritonitis. This sign is seen
in neonatal necrotizingenterocolitis.
- Reissers sign-iliac apophysis fuses with the iliac bone at
maturity .Thisindicates 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, inPneumoperitoneum.
- Rim sign-In severe hydronephrosis some times only a thin rim
of the contrastwill be seen outlining the kidney. This is due to
the contrast mediumcirculating in the capillaries compressed by the
dilated calyces.
- Roberts sign- appearance of gas shadow in the heart and great
vessels by 12hours of fetal death
- Romanas sign- in Chagas disease ,.there will be unilateral
painless oedemaof the periorbital tissues .it is due to infection
through the conjunctiva.
- Rombergs sign-It is a test to find out the loss of position
sense. It isspecial test to find out the Co-ordination of the lower
limbs. The patient isasked to stand with his feet close together
with both his eyes opened andclosed. If Rombergs sign is present as
soon as the patient closes his eye, hebegins to sway or may even
fall, It signifies sensory ataxia.
- Rope sign- due to constriction of hypopharynx in
poliomyelitis. There is acuteangulation between the chin 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 orflick the distal phalanges of the toes into
extension and then allow them tofall back to their normal position.
In pyramidal tract lesions, there will beplantar flexion of all the
other toes including the Great toe. (This isequivalent of Hoffmans
sign of the upper limbs)
- Rotchs sign- Flat note in the cardio hepatic angle on the
right side inpericardial effusion .
- Rovsings sign-In appendicitis, when the abdomen is pressed on
the left iliacregion ,there will be pain in the right side. This is
due to the stretching ofthe inflamed peritoneum on the right
side.(S)
- Sail sign- The sail shaped shadow of the thymus in the upper
mediastinalshadow.
- Sandwich sign- Mesenteric adenopathy.
- Schamroths sign .This is seen in clubbing .Normally when the
thumbs areplaced in close approximation to each other so that the
nails are facing eachother 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 calledShamroth sign.
- Scarf sign- The elbow crosses the midline when the arm is
crossed across thechest .Keep the head in the midline pull the hand
across the chest .The elbowwill cross the midline in preterm
babies..
- Schwartz sign- is seen in Otosclerosis. A pink tinge may be
seen due tootospongiotic mass (Flamingos tint)
- Scimitar sign- Crescentic shadow (Curved Turkish sword shaped
shadow) ofvascular density along the right border of the cardiac
silhouette. This is dueto anomalous pulmonary vein draining in to
the inferior vena cava.
- Scottish dog sign- is seen in spondylolysis. The defect is in
the parsinterarticularis.. 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 internalrotation of the hip will be full with hip extended ,but
will be grosslyrestricted with the hip flexed.
- Seidels sign- Sickle shaped extension of the blind spot above
or below ,orboth ,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 scleraabove the upper limbus will not be visible. In
hydrocephalus , eyes deviatedownward because of the impingement of
the dilated suprarenal recess on thetectum. .In normal new born
babies this may be visible transiently. Inkernicterus and
hydrocephalus it will be persistent
- Shawl sign- In dermatomyosistis .there will be erythema over
the upper backand shoulders.
- Shoulder sign-The hypertrophied pyloric muscle will cause an
indentation ofthe barium filled antrum in patients with
Hypertrophic pyloric stenosis.
- Shrug sign is seen in patello-femoral osteoarthritis.There
will be pain ,whenthe patella is compressed manually against the
femur during quadricepscontraction.
- 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 inchildren with inguinal hernia. .It is elicited by
palpating the spermatic cor dat the pubic tubercle.
- Soft neurological signs is a particular form of deviant
performance on amotor or sensory test in a neurological examination
that is abnormal for aparticular age. These are present in normal
children at some stage of theirdevelopment like .repetitive and
successive finger movements, foot taps,hopping, tandem walking.
- Spaldings sign- This is a radiological feature of intrauterine
deathoverlapping of the skull bones at the sutural lines and
shrinkage of the skullcontents in fetal death.
- Spatula sign- In tetanus, spasm of the child will be
aggravated, when thechilds mouth is pressed with a spatula.
- Spooning sign is seen in chorea. Ask the patient to stretch
the arms forwardand hold them parallel to the floor with the palms
facing each other. Theaffected arm will be flexed at the wrist and
extended at the metacarpophalangealjoints.This resembles a dinner
fork.( Dinner fork deformity)
- Steeple sign in croup.
- Steinberg sign- ( Thumb sign) -In Marfans syndrome ,Protrusion
of the thumbbeyond 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 bubblesof gas may be trapped between the valvular
conniventes
- Square root sign- on right ventricular pressure tracing in
constrictivepericarditis.
- Stellwag sign-(Staring look ) Infrequent blinking in
Thyrotoxicosis.
- String sign-is seen in Hypertrophic pyloric stenosis. In
barium meal study theelongated pyloric canal will be seen as a
single line of barium. Some times itwill be seen as a double
line.
- String sign of Kantor- in barium meal study.-Crohns disease is
due to themarked narrowing of the affected bowel.
- Sulcus sign a radiological sign in inferior dislocation of
shoulder ,wherethe 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 andwill cause pulsations over the back.. The pulsations
are prominent over thescapula 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 likea 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 theplate and through the part of the metaphysis.
- Tinels sign-When a regenerating nerve is tapped at the level
of regenerationthere will be a tingling sensation
- Tragers signThis is a sign of fetal death in utero. The fetal
attitude in a X-ray will bewith marked curvature or collapse of
spine. Loss of fetal attitude or posture isa result of decreased
muscle tone .
- Trail sign- Undue prominence of clavicular head of
sternomastoid muscle onone side is indicative of tracheal
displacement to that side .
- Tram track sign-Double track of barium will be seen outlining
the Hypertrophicmucosa 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
aorticregurgitation
- Trendelenburg sign-in congenital dislocation of hip. Ask the
patient to standon one leg and note the position of the pelvis. If
the test is negative thepelvis will be raised on the unsupported
side .If the test is positive thepelvis will drop on the
unsupported side.
- Trethowans sign- is positive in slipped femoral epiphysis.
Normally the linedrawn 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 andboth the hands placed behind him supporting on the
back as if in the tripodposition. On stretching the legs the
meninges are stretched which aggravatesthe 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 thegastric malignancy.
- Trolley track sign -Signs in Ankylosing spondylitis Three
vertical linerarlines with increased density will be seen.
- Trousseaus sign-Phlebo thrombosis of superficial veins.
- Trousseau's sign-Ischemia of the upper limb is caused by
inflating asphygmomanometer 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 thenerve root seconday to edema.
- Throgmortons sign-Extension of the suspensory ligament of the
penis prior tomicturition in newborn infants.( V )
- Vacuum cleft sign- is seen in vertebra plana.
- Vallecular sign-Retention of barium in hypopharynx in patients
with carcinomaof larynx.
- Vascular sign of Narath- is seen in anterior dislocation of
the hip joint. Thefemorals are easily felt in Scarpas triangle.
- Verumonten sign- is seen in complete rupture of urethra. The
prostate will befloating in per rectal examination.
- Von Graefes sign- in Thyrotoxicosis. Lag of the upper lid on
downward gaze.
- Von Rosens sign (Barlows sign ) In congenital instability of
the hip jointthe hips are held flexed and abducted , A click can be
heard when the femoralhead leaves the acetabulum .
- Victor Horsleys sign-The temperature will be 1-2 degree more
on theparalysed side.( W )
- Water Lily sign- Hydatid cyst.
- Watenberg 's sign.-The fingers of the hand to be examined
should be flexed andinterlocked to the examiners flexed fingers. A
pull in the opposite directionshould be applied , so that the
fingers of each other pull against other'sresistance. 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. Itwill be seen in congenital syphilis ,scurvy .
- Winter bottom sign- is seen in Trypanosoma brucei infection
Africantrypanosomiasis (Sleeping sickness).The regional nodes
enlarge in the posteriorcervical triangle..
- Wredens sign- is seen in a stillborn baby. Gelatinous material
more or lesscompletely fills the external auditory meatus.
- Wrist sign-It is seen in Marfans syndrome. Ask the patient to
grasp the wristwith the thumb and the little finger. There will be
overlapping of the fingers.
- W sitting- is seen in persistent anteversion of the femoral
neck .Childrensit 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 (Boorhaeves syndrome)- Deep lateral femoral notch
sign- Tibia vara due to retarded growth of medialhalf 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 insigmoid
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 cystSIGNS 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 SIGNSThe volume output from the left
ventricle is high and also there is a diastolicrun off. This causes
a rapid filling of the peripheral blood vessels and rapidemptying
of these vessels. This is the cause for the peripheral signs of
theaortic 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 beatsand 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 prominentlyin 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 nailbed. 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 withthe 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 iselicited 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 liverand the abdominal wall. Dogs 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, andpulmonary arteries with less
prominent aortic knuckle)- Hilar dance On fluoroscopy there is
conspicuous pulsation of the pulmonaryarteries.(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 iscalled 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 arestanding and sacral oedema
in recumbent 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 SIGNSa) 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 straightline 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 columnlesions. Romberg test.
The patient is asked to stand straight with both thefeet close to
each other .First the patient is asked to stand with the eyes
openand then with the eyes closed. In cases with posterior column
lesions where theposition sensation is lost, the patient will fall
on the side of the lesion whenthe eyes are closed. This is because
the patient adapts to the loss of positionsensation by the visual
assessment of the positions. When the eyes are closed orin 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 thetongue. c) Pronator sign d) Milk
maid sign-(Milking sign) e) Hung up reflex- With the patient
sitting on the bed with the legshanging freely the knee jerk is
elicited. The extension at the knee joint willbe maintained for
some time before the leg comes down. This is called hung upreflex
and occurs in the affected side. f) Spooning sign- g) Emotional
lability h) Czernys sign
6) SIGNS IN CIRRHOSIS LIVER - Dawsons sign - Terry nails
(leuconychia ) white nails seen in thumb and indexfingers .-
Dupuytrens contracture- Clubbing- Spider angiomata
7) SIGNS IN COARCTATION OF AORTA- - Docks sign - Suzmans
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 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 willdisappear
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 ENDOCARDITISAnemia
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 PetechiaeTender
splenomegaly Microscopic hematuriaRoth spots(F)
1) False localizing signs- Increased intracranial tension will
result in lateral rectus palsydue 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-- Roberts sign- Spalding sign- Balls
sign- Duels or halos sign - Trager sign
4) Signs of fracturea) 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. Meniscusshaped gastric ulcer with the concavity
pointed towards the gastric lumen b) Penetrating sign-The ulcer
crater should project from thecontrast filled lumen and erode in to
the stomach wall rather than in to themass in the stomach wall.
(H )1) Signs of congenital dysplasia of hip joint - Allis sign-
Galeazzi sign-- Trendelenburgs sign.
2) Signs of hydronephrosis- Rim sign
3) SIGNS IN HYPERTROPHIC PYLORIC STENOSIS. a) Target signb) Tram
track sign-c) String signd) Beak signe) Shoulder sign
4) SIGNS OF HYPOPARATHYROIDISM-a) Trousseau's sign-b) Chvosteks
sign5) EARLY SIGNS OF HYPOTHYROIDISM-Prolonged physiological
jaundice,Hypothermia,Hypotonia,Mottled skin,(I )
1) INTUSSUSCEPTION - Signs of intussusception area) Claw signb)
Pitch fork sign in barium enemac) 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 signsIn coma it will be difficult to
recognize the focal neurological signs .Thefollowing features wil
indicate the side of the lesiona) 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 narrowpalm.c) Wrist sign-(N )
1) SIGNS OF NERVE PARESISUlnar 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
.Theindex finger will be pointing. b) Simian or Ape like hand (Ape
thumb deformity)Thethumb lies in the plane of the hand due to
paralysis of the opponens and theshort flexor muscles. c) Inability
ot flex the interphalangeal joints due toparalysis 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 toserratus 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 ATROPHYSigns of
Optic atrophy Uthoffs phenomenon- Worsening of vision during fever
in hot weatheror after exercise .central conduction is slowed by
increase in the bodytemperature(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 sign
2) 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.
Inthe presence of Nuchal rigidity ,the child cannot kiss the knee
without bendingthe knee. - Phantom hernia-Bulge seen in the
abdominal wall due weakness ofabdominal muscles.6) SIGNS IN
PREGNANCY a) Hegars sign softening of cervix in pregnancy b)
Osianders sign (Vaginal sign) increased pulsations throughlateral
fornices .this occurs by 8 weeks of gestation. c) Goodells sign
(Cervical sign) Softening of the cervix withbluish discoloration by
6 weeks of gestation d) Jacquemiers sign (Ghadwicks sign) dusky hue
of the vestibuleand the anterior vaginal wall occurs by 8 weeks of
gestation e) Placental sign- Cyclical bleeding occurs up to 12
weeks ofpregnancy. f) Braxton Hicks sign- g) Ladins sign7) SIGNS IN
A PRETERM-a) Scarf sign The elbow crosses the midline when the arm
is crossed across thechest.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 atmaturity .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 L5vertebral body.4)
SYPHILISSigns of congenital syphilis Wimberger signX-ray knee
bilateral erosion in upper medial end oftibia(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
byinflating a sphygmomanometer cuff above the arterial pressure.
This willprecipitate the carpopedal spasm. b) Chvostek's sign-The
facial nerve is tapped at its exit from thestylomastoid foramen.
This leads to 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 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) Joffroys
sign-Absence of wrinkling on the forehead on lookingupwardse)
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 gapbetween the thickened patulous ileicecal valve and
narrowed ulcerated terminalileum . b) Stierlins sign- Th e terminal
ileum empties in to the stenoticascending 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 ,tendernesswill be present b) Pratts sign-Calf tenderness
on squeezing the calf from thesides. c) Homans 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 DEFICIENCIESa) Signs of Vitamin A deficiency
Bitots spots Xerosis (Corneal & conjunctival) KeratomalaciaToad
skin-Phrynoderma
b) Signs of Vitamin D deficiency-Rickets-Bossing of skull,
Rachitic rosary,Harrison sulcus, genu varum ,genu valgus, Genu
recurvatumHot 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 endc) Signs of Vitamin K
deficiency-Petechiae, purpura
d) 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 deficiencyBeefy red
tongue(Red ,painful ,swollen)-Niacin deficiency Bald tongue-
Vitamin B 12 deficiency.Vascularisation of cornea , Angular
stomatitis ,Angular blepharitis- Riboflavindeficiency .
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 thelimit of
the shaft will lead to formation of spur or marginal cleft.
b) Pelkens sign-Pelken spur- due to fracture of the Metaphyseal
corner.
c) Wimbergers sign
d) White line of Frenkel Thickened provisional zone (The zone of
provisionalcalcification at the epiphyseal ends of long bones.)
White line of Frenkel isdue 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 signetring.
g) Trummer feld zone (fragmented metaphysis)- Trummefeld zone is
rarefactionproximal to the white line.
h) Ground glass appearance of the shaft (Due to rarefaction)
i) Pencil cortex-Thinning of the cortexMISCELLANEOUS-1) Soft
neurological signs - Buttoning cloths, tying shoes, movements
ofhands.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 tensorfascia 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 elicited even by stroking the skin
high above in theleg.a) Oppenheims sign Heavy pressure is applied
by the thumb and index fingerfrom above downwards to anterior
surface of tibia (to its medial side). Theextensor response usually
occurs towards the end of the stimulation. b) Gordons reflex
Squeezing or applying deep pressure to calfmuscles or
tendo-achilles produce extensor plantar response.c) Chadocks sign
Extensor response is seen after striking the skin around thelateral
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 passiveplantar flexion of ankle. f)
Gonda sign Extensor response is elicited after forcefulstretching
or snapping of distal phalanx of either of the 2nd or 4th toe. g)
Brissauds reflex In patients with absent toe or amputated toethe
plantar extensor response cannot be seen by observing the great toe
sincesuch cases look for the contraction of the tensor fascia
lata.PSEUDO-BABINSKI'S SIGN The plantar extensor response may be
seen in the absence ofpyramidal tract lesions inn the following
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 theexaminer.The hand to be pronated. Sharp flickering
movement of terminal phalanx willproduce adduction and flexion of
the thumb and flexion of the other fingerssignifies pyramidal
lesion.b) Rossolimos Sign-Plantar surface of the Great toe is
tapped with a hammer orflick the distal phalanges of the toes into
extension and then allow them tofall back to their normal position.
In pyramidal tract lesions, there will beplantar flexion of all the
other toes including the Great toe. (This isequivalent of Hoffmans
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 acrescent of air.(In fungal ball aspergilloma )- Bare
area sign- is seen in pleural effusion .The peritoneal ligament
preventsascitic fluid from extending over the entire posterior
surface of the liver,where as in pleural space, the pleural fluid
may extend over the entireposterior 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 lateralfilm . ?he distance from the posterior
aspect of the inferior vena cava to theposterior border of the
heart horizontally at a level 2 cm above theintersection of
diaphragm and inferior vena cava.- Interface sign- is seen in
pleural effusion .interface between the spleenand the pleural fluid
will be less 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 inter phalangeal joints.- Rail road
calcification- Struge Weber syndrome- Westermarks sign - an area of
pulmonary under perfusion in acute massivepulmonary embolism. There
is focal oligemia in the embolised zone.ANGIOGRAPHY- Sting of beads
Segmental irregularity of medium and small sized arteries
infibromuscular 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 growthEARLIEST 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 ofnormal onychodermal angle is a
reliable sign)- Early sign in scurvy is seen around the kneesThe
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
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