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Mechanisms of Clinical Signs - EPub3

Mechanisms of Clinical Signs - EPub3

Mark Dennis | William Talbot Bowen | Lucy Cho

(2015)

Additional Information

Book Details

Abstract

What causes that condition?

What does it mean?

Organised by body system, Mechanisms of Clinical Signs, 2nd Edition explains the underlying mechanism and value of the clinical signs you are expected to know, and the conditions they indicate. Each chapter contains descriptions of clinical signs, a list of the conditions they are associated with (what conditions the signs indicate), an explanation of the mechanism and the 'value' of those signs (how reliable they are as an indication of a condition).

There is a uniform set of subheadings for each sign:

  • Description
  • Condition/s associated with
  • Mechanism/s
  • Sign value

The explanations for the mechanisms underlying each sign are brief but accurate and informative, and provide sufficient information for the reader to understand the mechanism:

  • Signs are ordered alphabetically within each chapter outlining a specific body system
  • Extensive reference lists of up-to-date literature strengthen the authority of the content
  • Video and audio content presents real life evaluation scenarios of clinical signs
  • Clinical Pearls highlight the main signs which students and trainees should look out for to help them identify conditions with which the patients present
  • New images are added to depict clinical signs where no images were present in the previous edition

Table of Contents

Section Title Page Action Price
Front Cover cover
Inside Front Cover ifc1
Half title page i
Dedication ii
Mechanisms of clinical signs iii
Copyright Page iv
Table Of Contents v
Contents by Condition ix
Foreword xv
Preface xvi
Acknowledgements xvi
Reviewers xvii
Abbreviations xix
Sign Value xxii
1 Musculoskeletal Signs 1
Anterior drawer test 2
Description 2
Condition/s associated with 2
Mechanism/s 2
Sign value 2
Apley’s grind test 3
Description 3
Condition/s associated with 3
Mechanism/s 3
Sign value 3
Apley’s scratch test 4
Description 4
Condition/s associated with 4
Common 4
Mechanism/s 4
Sign value 4
Apparent leg length inequality (functional leg length) 5
Description 5
Condition/s associated with 5
Mechanism/s 5
Ligamentous laxity 5
Joint contracture 5
Altered foot mechanics 5
Sign value 6
Apprehension test 7
Description 7
Condition/s associated with 7
More common – traumatic 7
Less common – atraumatic 7
Mechanism/s 7
Sign value 7
Apprehension–relocation test (Fowler’s sign) 8
Description 8
Condition/s associated with 8
Less common – atraumatic 8
Mechanism/s 8
Sign value 8
Bouchard’s and Heberden’s nodes 9
Description 9
Condition/s associated with 9
Mechanism/s 9
Sign value 9
Boutonnière deformity 10
Description 11
Condition/s associated with 11
Mechanism/s 11
Inflammatory arthropathy (e.g. rheumatoid arthritis) 11
Trauma 11
Sign value 11
Bulge/wipe/stroke test 12
Description 12
Condition/s associated with 12
More common 12
Less common 12
Mechanism/s 12
Sign value 12
Butterfly rash (malar rash) 13
Description 13
Condition/s associated with 13
Common 13
Mechanism/s 13
Sign value 14
Calcinosis/calcinosis cutis 15
Description 15
Condition/s associated with 15
Mechanism/s 15
Dystrophic calcinosis 15
Metastatic calcinosis 15
Iatrogenic 16
Idiopathic 16
Sign value 16
Charcot foot 17
Description 17
Condition/s associated with 17
Mechanism/s 17
Sign value 18
Crepitus 19
Description 19
Condition/s associated with 19
General mechanism/s 19
Rheumatoid/osteoarthritis 19
Sign value 19
Dropped arm test 20
Description 20
Condition/s associated with 20
Mechanism/s 20
Sign value 20
Finkelstein’s test 21
Description 21
Condition/s associated with 21
Mechanism/s 21
Sign value 21
Gottron’s papules 22
Description 22
Condition/s associated with 22
Mechanism/s 22
Sign value 22
Hawkins’ impingement test 23
Description 23
Condition/s associated with 23
Mechanism/s 23
Sign value 24
Heliotrope rash 25
Description 25
Condition/s associated with 25
Mechanism/s 25
Sign value 25
Kyphosis 26
Description 26
Condition/s associated with 26
More common 26
Less common 26
Mechanism/s 26
Osteoporosis/degenerative joint disease 26
Congenital kyphosis 26
Scheuermann kyphosis 26
Sign value 27
Lachman’s test 28
Description 28
Condition/s associated with 28
Mechanism/s 28
Sign value 28
Livedo reticularis 29
Description 29
Condition/s associated with 29
More common 29
Less common 29
General mechanism/s 29
Primary or idiopathic livedo reticularis 30
Hypothermia (autonomic nervous system) 30
Elderly 30
Anti-phospholipid syndrome 30
Cryoglobulinaemia 31
Sign value 31
McMurray’s test 32
Description 32
Condition/s associated with 32
Mechanism/s 32
Sign value 32
Neer’s impingement test 33
Description 33
Condition/s associated with 33
Mechanism/s 33
Sign value 33
Patellar apprehension test 35
Description 35
Condition/s associated with 35
Mechanism/s 35
Sign value 35
Patellar tap 36
Description 36
Condition/s associated with 36
More common 36
Less common 36
Mechanism/s 36
Sign value 36
Patrick’s test (FABER test) 37
Description 37
Condition/s associated with 37
More common 37
Less common 37
Mechanism/s 37
Sign value 37
Phalen’s sign 38
Description 38
Condition/s associated with 38
Mechanism/s 38
Sign value 38
Proximal weakness/proximal myopathy 39
Description 39
Condition/s associated with 39
Mechanism/s 39
Inflammatory myopathies 39
Systemic disorders 39
Sign value 39
Psoriatic nails/psoriatic nail dystrophy 40
Description 40
Condition/s associated with 40
Mechanism/s 40
Nail pitting 41
Subungual keratosis 41
Oil drops 41
Salmon patches 41
Splinter haemorrhages 41
Sign value 41
Raynaud’s syndrome/phenomenon 42
Description 42
Condition/s associated with 43
Common 43
Less common 43
Mechanism/s 43
Secondary Raynaud’s syndrome 43
Saddle nose deformity 45
Description 45
Condition/s associated with 45
More common 45
Less common 45
Mechanism/s 45
Wegener’s granulomatosis 45
Relapsing polychondritis 45
Sign value 45
Sausage-shaped digits (dactylitis) 46
Description 46
Condition/s associated with 46
More common 46
Uncommon 46
Mechanism/s 46
Spondyloarthropathies 46
Tuberculosis dactylitis 46
Syphilitic dactylitis 46
Sarcoid dactylitis 46
Sickle cell dactylitis 46
Sign value 47
Sclerodactyly 48
Description 48
Condition/s associated with 48
Mechanism/s 48
Sign value 48
Shawl sign 49
Description 49
Condition/s associated with 49
Mechanism/s 49
Sign value 49
Simmonds–Thompson test 50
Description 50
Condition/s associated with 50
Mechanism/s 50
Sign value 50
Speed’s test 51
Description 51
Condition/s associated with 51
Mechanism/s 51
Sign value 51
Subcutaneous nodules (rheumatoid nodules) 52
Description 52
Condition/s associated with 52
Mechanism/s 52
Sign value 52
Sulcus sign 53
Description 53
Condition/s associated with 53
Mechanism/s 53
Sign value 53
Supraspinatus test (empty-can test) 54
Description 54
Condition/s associated with 54
Mechanism/s 54
Sign value 54
Swan-neck deformity 55
Description 55
Condition/s associated with 55
Common 55
Mechanism/s 55
Sign value 56
Telangiectasia 57
Description 57
Condition/s associated with 57
General mechanism/s 57
Hereditary haemorrhagic telangiectasia (HHT) 57
Scleroderma 57
Spider naevus 58
Sign value 58
Thomas’ test 59
Description 59
Condition/s associated with 59
Mechanism/s 59
Sign value 59
Tinel’s sign 60
Description 60
Condition/s associated with 60
Mechanism/s 60
Sign value 60
Trendelenburg’s sign 61
Description 61
Condition/s associated with 61
Mechanism/s 61
Sign value 61
True leg length inequality (anatomic leg length inequality) 62
Description 62
Condition/s associated with 62
Mechanism/s 62
Sign value 62
Ulnar deviation 63
Description 63
Condition/s associated with 63
Mechanism/s 63
Metacarpophalangeal (MCP) joint 63
Radiocarpal ulnar deviation 63
Sign value 63
V-sign 64
Description 64
Condition/s associated with 64
Mechanism/s 64
Sign value 64
Valgus deformity 65
Description 65
Condition/s associated with 65
Mechanism/s 65
Hallux valgus 65
Knee valgus (genu valgum) 66
Sign value 66
Varus deformity 68
Description 68
Condition/s associated with 68
Mechanism/s 68
Coxa vara 68
Congenital 68
Rickets 68
Perthes’ disease 69
Genu varum 69
Blount’s disease 69
Hallux varus 69
Sign value 69
Yergason’s sign 70
Description 70
Condition/s associated with 70
Mechanism/s 70
Sign value 71
References 72
2 Respiratory Signs 77
Accessory muscle breathing 78
Description 79
Condition/s associated with 79
Mechanism/s 79
Sign value 79
Agonal respiration 80
Description 80
Condition/s associated with 80
Mechanism/s 80
Sign value 80
Apneustic breathing (also apneusis) 81
Description 81
Condition/s associated with 81
Mechanism/s 81
Sign value 81
Apnoea 82
Description 82
Condition/s associated with 82
Central sleep apnoea (CSA) 82
Obstructive sleep apnoea (OSA) 82
Mechanism/s 82
Central sleep apnoea 82
Obstructive sleep apnoea 82
Sign value 84
Asterixis 85
Description 85
Condition/s associated with 85
More common 85
Less common 85
Mechanism/s 85
Sign value 85
Asymmetrical chest expansion 86
Description 86
Condition/s associated with 86
More common 86
Less common 86
Mechanism/s 86
Pneumonia, pleural effusions 87
Foreign body 87
Flail segment 87
Kyphoscoliosis 87
Unilateral diaphragm paralysis 87
Sign value 88
Asynchronous respiration 89
Description 89
Condition/s associated with 89
Mechanism/s 89
Sign value 89
Ataxic (Biot’s) breathing 90
Description 90
Condition/s associated with 90
More common 90
Less common 90
Mechanism/s 90
Sign value 90
Barrel chest 92
Description 92
Condition/s associated with 92
Mechanism/s 93
Bradypnoea 94
Description 94
Condition/s associated with 94
More common 94
Less common 94
Mechanism/s 94
Sign value 94
Breath sounds 95
3 Cardiovascular Signs 165
Apex beat (also cardiac impulse) 166
Description 166
Apex beat: displaced 167
Description 167
Condition/s associated with 167
More common 167
Less common 167
Mechanism/s 167
Sign value 167
Apex beat: double or triple impulse 168
Description 168
Condition/s associated with 168
Mechanism/s 168
Sign value 168
Apex beat: hyperdynamic apical impulse/volume-loaded 169
Description 169
Condition/s associated with 169
More common 169
Less common 169
Mechanism/s 169
Sign value 169
Apex beat: left ventricular heave/sustained apical impulse/pressure-loaded apex 170
Description 170
Condition/s associated with 170
More common 170
Less common 170
Mechanism/s 170
Sign value 170
Apex beat: tapping 171
Description 171
Conditions associated with 171
Mechanism/s 171
Sign value 171
Arterial pulse 172
Arterial pulse: anacrotic pulse 175
Description 175
Condition/s associated with 175
Mechanism/s 175
Sign value 175
Arterial pulse: bigeminal 176
Definition 176
Condition/s associated with 176
Mechanism/s 176
Arterial pulse: dicrotic 177
Description 177
Condition/s associated with 177
Mechanism/s 177
Sign value 177
Arterial pulse: pulsus alternans 178
Description 178
Condition/s associated with 178
Mechanism/s 178
Sign value 179
Arterial pulse: pulsus bisferiens 180
Description 180
Condition/s associated with 180
More common 180
Less common 180
General mechanism/s 181
Hypertrophic cardiomyopathy 181
Sign value 181
Arterial pulse: pulsus parvus et tardus 182
Description 182
Condition/s associated with 182
Mechanism/s 182
Sign value 182
Arterial pulse: sinus arrhythmia 184
Description 184
Condition/s associated with 184
Mechanism/s 184
Sign value 184
Bradycardia 185
Description 185
Condition/s associated with 185
More common 185
Less common 185
Mechanism/s 185
Myocardial infarction 185
Cellular hypoxia 185
Sinus node disease 185
Heart block 185
Electrolyte imbalances 185
Haemochromatosis 186
Drugs 186
Sign value 186
Buerger’s sign 187
Description 187
Condition/s associated with 187
Mechanism/s 187
Sign value 187
Capillary return decreased/delayed 188
Description 188
Condition/s associated with 188
Mechanism/s 188
Dehydration mechanism/s 188
Decreased peripheral perfusion mechanism/s 188
Shocked state mechanism/s 188
Sign value 189
Cardiac cachexia 190
Description 190
Condition/s associated with 190
Mechanism/s 191
Sign value 191
Carotid bruit 192
Description 192
Condition/s associated with 192
More common 192
Less common 192
Mechanism/s 192
Sign value 192
Cheyne–Stokes breathing 193
Description 193
Condition/s associated with 194
More common 194
Less common 194
Mechanism/s 194
Mechanism/s in congestive heart failure 194
Sign value 195
Clubbing 196
Description 196
Condition/s associated with 196
Mechanism/s 196
Sign value 197
Crackles (also rales) 198
Description 198
Condition/s associated with 198
More common 198
Mechanism/s 198
Heart failure 198
Other 198
Sign value 198
Cyanosis 199
Cyanosis: central 200
Description 200
Condition/s associated with 200
More common 200
Less common 200
Mechanism/s 200
Cardiac 200
Respiratory 200
Haematological 201
Cyanosis: peripheral 202
Description 202
Condition/s associated with 202
Common 202
Less common 202
Mechanism/s 202
Ewart’s sign 203
Description 203
Condition/s associated with 203
Mechanism/s 203
Hepatojugular reflux (also abdominojugular reflux) 204
Description 204
Condition/s associated with 204
Mechanism/s 204
Sign value 204
Hypertensive retinopathy 206
Sign value 206
Hypertensive retinopathy: arteriovenous (AV) nipping (or AV nicking) 207
Description 207
Condition/s associated with 207
Mechanism/s 207
Hypertensive retinopathy: copper and silver wiring 208
Description 208
Condition/s associated with 208
Mechanism/s 208
Hypertensive retinopathy: cotton wool spots 209
Description 209
Condition/s associated with 209
More common 209
Less common 209
Mechanism/s 209
Hypertensive retinopathy: microaneurysms 210
Description 210
Condition/s associated with 210
Mechanism/s 210
Hypertensive retinopathy: retinal haemorrhage 211
Description 211
Condition/s associated with 211
More common 211
Less common 211
Mechanism/s 211
Hypertrophic obstructive cardiomyopathy murmur 212
Description 212
Condition/s associated with 212
Mechanism/s 212
Mechanism/s of dynamic manoeuvres on outflow tract murmurs. 212
Janeway lesions 214
Definition 214
Condition/s associated with 214
Mechanism/s 214
Sign value 214
Jugular venous pressure (JVP) 215
JVP: Kussmaul’s sign 217
Description 217
Condition/s associated with 217
More common 217
Less common 217
Mechanism/s 217
Sign value 218
JVP: raised 219
Description 219
Condition/s associated with 219
Mechanism/s 219
Sign value 219
JVP: the normal waveform 221
JVP waveform variations: a-waves – cannon 222
Description 222
Condition/s associated with 222
More common 222
Less common 222
Mechanism/s 222
JVP waveform variations: a-waves – prominent or giant 224
Description 224
Condition/s associated with 224
Mechanism/s 224
JVP waveform variations: v-waves – large 226
Description 226
Condition/s associated with 226
Mechanism/s 226
Sign value 226
JVP waveform variations: x-descent – absent 227
Description 227
Condition/s associated with 227
Mechanism/s 227
JVP waveform variations: x-descent – prominent 228
Description 228
Condition/s associated with 228
Mechanism/s 228
Sign value 228
JVP waveform variations: y-descent – absent 229
Description 229
Condition/s associated with 229
Most common 229
Less common 229
Mechanism/s 230
JVP waveform variations: y-descent – prominent (Friedrich’s sign) 231
Description 231
Condition/s associated with 231
More common 231
Less common 231
Mechanism/s 231
Sign value 231
Mid-systolic click 233
Description 233
Condition/s associated with 233
Mechanism/s 233
Mechanisms of dynamic manoeuvres 233
Sign value 233
Mitral facies 235
Description 235
Condition/s associated with 235
Mechanism/s 235
Mottling 236
Description 236
Condition/s associated with 236
Mechanism/s 236
Sign value 236
Murmurs 237
Murmurs – systolic: aortic stenotic murmur 238
Description 238
Condition/s associated with 238
Mechanism/s 239
Age-related degeneration (‘senile calcification’) 239
Rheumatic heart disease 239
Dynamic manoeuvres mechanisms 239
Sign value 239
Murmurs – systolic: mitral regurgitation murmur 241
Description 241
Condition/s associated with 241
More common causes 241
General mechanism/s 241
Rheumatic heart disease 241
Infective endocarditis 241
Cardiomyopathy 242
Ischaemic heart disease 242
Myxomatous degeneration 242
Dynamic manoeuvres mechanism 242
Sign value 242
Murmurs – systolic: pulmonary stenotic murmur 243
Description 243
Condition/s associated with 243
Mechanism/s 243
Congenital 243
Carcinoid syndrome 243
Murmurs – systolic: tricuspid regurgitation murmur (also Carvello’s sign) 244
Description 244
Condition/s associated with 244
More common 244
Less common 244
General mechanism/s 244
Right ventricular dilatation 244
Carcinoid syndrome 245
Connective tissue disease 245
Rheumatic fever 245
Sign value 245
Murmurs – systolic: ventricular septal defect murmur 246
Description 246
Condition/s associated with 246
Mechanism/s 246
Dynamic manoeuvres mechanism 246
Sign value 246
Murmurs – diastolic: aortic regurgitation 248
Description 248
Condition/s associated with 248
More common 248
Less common 248
Mechanism/s 248
Dynamic manoeuvres mechanisms 248
Sign value 248
Murmurs – diastolic: eponymous signs of aortic regurgitation 250
Murmurs – diastolic: Graham Steell murmur 252
Description 252
Condition/s associated with 252
Mechanism/s 252
Murmurs – diastolic: mitral stenotic murmur 253
Description 253
Condition/s associated with 253
Mechanism/s 253
Sign value 253
Murmurs – diastolic: opening snap (OS) 254
Description 254
Condition/s associated with 254
Mechanism/s 254
Sign value 254
Murmurs – diastolic: pulmonary regurgitation murmur 255
Description 255
Condition/s associated with 255
More common 255
Less common 255
Mechanism/s 255
Sign value 255
Murmurs – diastolic: tricuspid stenotic murmur 256
Description 256
Condition/s associated with 256
More common 256
Less common 256
Mechanism/s 256
Murmurs – continuous: patent ductus arteriosus murmur 257
Description 257
Condition/s associated with 257
Mechanism/s 257
Osler’s nodes 259
Definition 259
Condition/s associated with 259
More common 259
Less common 259
Mechanism/s 259
Sign value 259
Passive leg raise with blood pressure or pulse pressure change 260
Description 260
Conditions/s associated with 260
Mechanism/s 260
Sign value 260
Pericardial knock 261
Description 261
Condition/s associated with 261
Mechanism/s 261
Sign value 261
Pericardial rub 262
Description 262
Condition/s associated with 262
Mechanism/s 262
Peripheral oedema 263
Definition 263
Condition/s associated with 263
More common 263
Less common 263
Mechanism/s 263
Mechanism in heart failure 263
Liver disease 264
Nephrotic syndrome 264
Sign value 265
Pulse pressure 267
Pulse pressure: narrow 268
Description 268
Condition/s associated with 268
Common 268
Less common 268
Mechanism/s 268
Cardiac failure 268
Shock 268
Pulse pressure variation 270
Definition 270
Condition/s associated with: 270
Mechanism/s 270
Sign value 273
Pulse pressure: widened 274
Description 274
Condition/s associated with 274
Most common 274
Mechanism/s 274
Old age 274
Septic shock 274
Aortic regurgitation 274
Hyperthyroidism 274
Sign value 275
Pulsus paradoxus 277
Description 277
Condition/s associated with 277
More common 277
Less common 277
General mechanism/s 278
Cardiac tamponade 278
Massive pulmonary embolism 278
Respiratory disorders 279
Sign value 279
Radial–radial delay 281
Description 281
Condition/s associated with 281
Mechanism/s 281
Sign value 281
Radio-femoral delay 282
Description 282
Condition/s associated with 282
Mechanism/s 282
Sign value 282
Right ventricular heave 283
Description 283
Condition/s associated with 283
More common 283
Less common 283
General mechanism/s 283
Mitral regurgitation 283
Roth spots 284
Description 284
Condition/s associated with 284
More common 284
Less common 284
Mechanism/s 284
Sign value 284
S1 (first heart sound): normal 286
Description 286
Mechanism/s 286
S1 (first heart sound): accentuated 287
Description 287
Condition/s associated with 287
General mechanism/s 287
Shortened PR interval 287
Mild mitral stenosis 287
High cardiac output states 287
Sign value 287
S1 (first heart sound): diminished 288
Description 288
Condition/s associated with 288
General mechanism/s 288
Lengthened PR interval 288
Mitral regurgitation 288
Severe mitral stenosis 288
Left ventricle with reduced compliance 288
S2: loud (or loud P2 – pulmonary component of second heart sounds) 289
Definition 289
Condition/s associated with 289
Mechanism/s 289
Sign value 289
S3 (third heart sound) 290
Description 290
Condition/s associated with 290
More common 290
Less common 290
Mechanism/s 290
Heart failure mechanism 290
Sign value 290
S4 (fourth heart sound) 291
Description 291
Condition/s associated with 291
Common 291
Less common 291
Mechanism/s 291
Sign value 291
Skin turgor: decreased 292
Description 292
Condition/s associated with 292
Mechanism/s 292
Ehlers–Danlos syndrome mechanism 292
Sign value 292
Splinter haemorrhages 293
Description 293
Condition/s associated with 293
Mechanism/s 293
Sign value 293
Splitting of the heart sounds 294
Splitting heart sounds: physiological splitting 295
Description 295
Condition/s associated with 295
Mechanism/s 295
Splitting heart sounds: paradoxical (reverse) splitting 297
Description 297
Condition/s associated with 297
Mechanism/s 297
Aortic stenosis 297
Left bundle branch block (LBBB) 298
Sign value 298
Splitting heart sounds: widened splitting 299
Description 299
Condition/s associated with 299
Mechanism/s 299
Pulmonary stenosis 299
Right bundle branch block (RBBB) 299
Mitral regurgitation 299
Sign value 299
Splitting heart sounds: widened splitting – fixed 300
Description 300
Condition/s associated with 300
Mechanism/s 300
Sign value 300
Tachycardia (sinus) 301
Description 301
Condition/s associated with 301
More common 301
Less common 301
Mechanism/s 301
Mechanism in hyperthyroidism 301
Sign value 301
Xanthelasmata 303
Description 303
Condition/s associated with 303
Mechanism/s 303
Hyperlipidaemic 303
Normolipidaemic 303
Sign value 303
References 305
4 Haematological and Oncological Signs 313
Angular stomatitis 314
Description 314
Condition/s associated with 314
More common 314
Less common 314
Nutritional deficiency mechanism/s 314
Sign value 314
Atrophic glossitis 315
Description 315
Condition/s associated with 315
More common 315
Less common 315
Mechanism/s 315
Sign value 315
Bone tenderness/bone pain 316
Description 316
Condition/s associated with 316
More common 316
General mechanism/s 316
Complication of direct malignant invasion 316
Malignancy-induced osteoclast/osteoblast imbalance 316
Alteration of normal pain pathways 318
Sign value 318
Chipmunk facies 319
Description 319
Condition/s associated with 319
Beta thalassaemia mechanism/s 319
Conjunctival pallor 321
Description 321
Condition/s associated with 321
Mechanism/s 321
Sign value 321
Ecchymoses, purpura and petechiae 322
Description 322
General mechanism/s 322
Thrombocytopenia 322
Vasculitis 323
Cushing’s 323
Mechanism of colour changes 323
Sign value 323
Gum hypertrophy (gingival hyperplasia) 324
Description 324
Condition/s associated with 324
Leukaemia mechanism/s 324
Drug-induced mechanism/s 324
Sign value 324
Haemolytic/pre-hepatic jaundice 325
Description 325
Condition/s associated with 325
General mechanism/s 325
Drug-induced mechanism/s 326
Sign value 328
Koilonychia 329
Description 329
Condition/s associated with 329
More common 329
Less common 329
Mechanism/s 329
Sign value 329
Leser–Trélat sign 330
Description 330
Condition/s associated with 330
More common 330
Less common 330
Mechanism/s 330
Sign value 330
Leucoplakia 331
Description 331
Condition/s associated with 331
Mechanism/s 331
Sign value 331
Lymphadenopathy 332
Description 332
Condition/s associated with 332
General mechanism/s 332
Malignancy 332
Infectious causes 332
Autoimmune 332
Sign value 334
Painful versus painless nodes 334
Neoplastic fever 337
Description 337
Condition/s associated with 337
Mechanism/s 337
Sign value 337
Peau d’orange 338
Description 338
Condition/s associated with 338
More common 338
Less common 339
General mechanism/s 339
Breast cancer 339
Sign value 339
Prostate (abnormal) 340
Description 340
Condition/s associated with 340
Prostate cancer mechanism/s 340
Prostatitis mechanism/s 340
Prostate cancer screening 340
Rectal mass 341
Description 341
Condition/s associated with 341
Colorectal cancer screening 341
Trousseau’s sign of malignancy 342
Description 342
Condition/s associated with 342
More common 342
Less common 342
Mechanism/s 342
Tissue factor 343
Carcinoma mucins 343
Oncogene activation 343
Tissue hypoxia 343
Other causes 343
Sign value 343
References 344
5 Neurological Signs 347
Guide to the ‘Relevant neuroanatomy and topographical anatomy’ boxes 348
Abducens nerve (CNVI) palsy 350
Description 350
Condition/s associated with 350
Common 350
Less common 350
Mechanism/s 350
Disorders of the subarachnoid space 350
Diabetic mononeuropathy and microvascular infarction 352
Elevated intracranial pressure, the ‘false localising sign’ 352
Cavernous carotid artery aneurysm and cavernous sinus syndrome 352
Orbital apex syndrome 352
Sign value 352
Anisocoria 354
Description 354
Condition/s associated with 355
Common 355
Less common 355
Mechanism/s 355
Anisocoria more prominent in the dark 355
Horner’s syndrome 355
Pupillary constrictor muscle spasm 355
Drugs 355
Anisocoria more prominent in bright light 357
Oculomotor nerve (CNIII) palsy 357
Adie’s tonic pupil 357
Damage to the neuromuscular structures of the iris 357
Drugs 358
Sign value 358
Anosmia 359
Description 359
Condition/s associated with 359
Common 359
Less common 359
Mechanism/s 359
Olfactory cleft obstruction 359
Inflammatory disorders of the olfactory neuroepithelium 359
Traumatic injury of the olfactory nerves 360
Olfactory bulb or tract lesion 361
Neurodegenerative disease of the cerebral cortex 361
Normal ageing 361
Sign value 361
Argyll Robertson pupils and light–near dissociation 362
Description 362
Condition/s associated with 362
Mechanism/s 362
Sign value 362
Ataxic gait 365
Description 365
Condition/s associated with 365
Common 365
Less common 365
Mechanism/s 365
Cerebellar vermis lesion 365
Lateral hemisphere lesion 366
Sign value 367
Atrophy (muscle wasting) 368
Description 368
Condition/s associated with 368
Common 368
Less common 369
Mechanism/s 369
Lower motor neuron disorders 369
Disuse atrophy 369
Myopathy 369
Peripheral vascular disease 369
Sign value 370
Babinski response 372
Description 372
Condition/s associated with 372
Common 372
Less common 372
Mechanism/s 372
Sign value 372
Bradykinesia 374
Description 374
Condition/s associated with 374
Common 374
Less common 375
Mechanism/s 375
Parkinson’s disease and the Parkinson’s plus syndromes 376
Dopamine antagonists 376
Sign value 376
Broca’s aphasia (expressive aphasia) 377
Description 377
Condition/s associated with 377
Common 377
Less common 377
Mechanism/s 377
Sign value 377
Brown-Séquard syndrome 380
Description 380
Condition/s associated with 380
Common 380
Less common 380
Mechanism/s 380
Sign value 380
Brudzinski sign 383
Description 383
Condition/s associated with 383
Mechanism/s 383
Sign value 383
Cavernous sinus syndrome 384
Description 384
Condition/s associated with 384
Common 384
Less common 384
Mechanism/s 384
Septic thrombosis 385
Aseptic thrombosis 385
Cavernous internal carotid artery aneurysm 385
Pituitary apoplexy 385
Disorders of the sphenoid and ethmoid sinuses 385
Sign value 386
Clasp-knife phenomenon 387
Description 387
Condition/s associated with 387
Common 387
Less common 387
Mechanism/s 387
Sign value 387
Clonus 388
Description 388
Condition/s associated with 388
Common 388
Less common 388
Mechanism/s 388
Upper motor neuron lesion 388
Serotonin syndrome 388
Sign value 389
Cogwheel rigidity 390
Description 390
Condition/s associated with 390
Common 390
Less common 390
Mechanism/s 390
Sign value 390
Corneal reflex 392
Description 392
Condition/s associated with 392
Common 392
Less common 392
Mechanism/s 392
Facial nerve palsy 392
Disorders of the ophthalmic division of the trigeminal nerve (CNV V1) 392
Disorders of the cornea 393
Sign value 393
Crossed-adductor reflex 395
Description 395
Condition/s associated with 395
Common 395
Less common 395
Mechanism/s 395
Sign value 395
Dysarthria 396
Description 396
Condition/s associated with 396
Common 396
Less common 396
Mechanism/s 396
Disorders of the cerebellum 396
Disorders of the upper motor neuron 397
Disorders of the lower motor neuron 397
Disorders of the oral cavity and oropharynx 397
Sign value 397
Dysdiadochokinesis 398
Description 398
Condition/s associated with 398
Common 398
Less common 398
Mechanism/s 398
Sign value 398
Dysmetria 400
Description 400
Condition/s associated with 400
Common 400
Less common 400
Mechanism/s 400
Sign value 401
Dysphonia 402
Description 402
Condition/s associated with 402
Common 402
Less common 402
Mechanism/s 402
Local disorders of the vocal cords and larynx 402
Disorders of glossopharyngeal nerve, vagus nerve and recurrent laryngeal nerve 402
Disorders of the brainstem 403
Sign value 403
Essential tremor 404
Description 404
Condition/s associated with 404
Common 404
Less common 404
Mechanism/s 404
Sign value 404
Facial muscle weakness (unilateral) 406
Description 406
Condition/s associated with 406
Upper motor neuron 406
Common 406
6 Gastroenterological Signs 570
Ascites 571
Description 571
Condition/s associated with 571
Mechanism/s 571
Peripheral arterial vasodilatation theory 571
Liver disease 573
Congestive heart failure, Budd–Chiari syndrome 573
Nephrotic syndrome 573
Myxoedema mechanism/s 574
Exudative ascites 574
Chylous ascites 575
Nephrogenic – haemodialysis 575
Ascites clinical signs 575
Sign value 577
Asterixis (also hepatic flap) 580
Description 580
Condition/s associated with 580
Hepatic mechanism/s 580
Sign value 580
Bowel sounds 581
Sign value 581
Bowel sounds: absent 582
Description 582
Condition/s associated with 582
More common 582
Less common 582
General mechanism/s 582
Bowel obstruction 582
Infection 582
Postoperative ileus 582
Hypokalaemia 583
Pseudo-obstruction 583
Bowel sounds: hyperactive (borborygmus) 584
Description 584
Condition/s associated with: 584
More common 584
Less common 584
Mechanism/s 584
Bowel sounds: tinkling 585
Description 585
Condition/s associated with 585
Mechanism/s 585
Sign value 585
Caput medusae 586
Description 586
Condition/s associated with 586
Mechanism/s 586
Sign value 586
Cheilitis granulomatosa 588
Description 588
Condition/s associated with 588
Mechanism/s 588
Sign value 588
Coffee ground vomiting/bloody vomitus/haematemesis 589
Description 589
Condition/s associated with 589
More common 589
Less common 589
General mechanism/s 589
Peptic ulcer disease 589
Mallory–Weiss tear 589
Oesophageal varices 589
Sign value 590
Courvoisier’s sign 591
Description 591
Condition/s associated with 591
Mechanism/s 591
Sign value 591
Cullen’s sign 593
Description 593
Condition/s associated with 593
More common 593
Less common 593
Mechanism/s 593
Sign value 594
Erythema nodosum 595
Description 595
Condition/s associated with 595
More common 595
Mechanism/s 595
Sign value 596
Grey Turner’s sign 597
Description 597
Condition/s associated with 597
Mechanism/s 597
Sign value 597
Guarding 598
Description 598
Condition/s associated with 598
Mechanism/s 598
Sign value 598
Gynaecomastia 599
Description 599
Condition/s associated with 599
More common 599
Less common 599
General mechanism/s 599
Physiological gynaecomastia 600
Drugs 600
Hepatic cirrhosis 600
Hyperthyroidism 601
Hypogonadism 601
Re-feeding syndrome 601
Renal failure and dialysis 601
Testicular tumours 601
Sign value 601
Haematuria 602
Description 602
Condition/s associated with 602
Common 602
Less common 602
Mechanism/s 602
Sign value 602
Hepatic encephalopathy 604
Description 604
Condition/s associated with 604
Mechanism/s 604
Ammonia hypothesis 604
Bacterial products 604
GABA-ergic hypothesis 604
Benzodiazepine hypothesis 605
Manganese hypothesis 605
Neuroinflammation and TNF-α – a unifying theory? 605
Oxidative stress 606
Sign value 606
Hepatic foetor 607
Description 607
Condition/s associated with 607
Mechanism/s 607
Sign value 607
Hepatic venous hum 608
Description 608
Condition/s associated with 608
Mechanism/s 608
Hepatomegaly 609
Description 609
Condition/s associated with 609
Mechanism/s 609
Congestive heart failure 609
Infective 609
Infiltrative 609
Vascular 609
Sign value 610
Jaundice 611
Description 611
Condition/s associated with 611
Mechanism/s 611
Pre-hepatic 611
Intrahepatic 611
Drug-induced liver injury 612
Post-hepatic 612
Sign value 612
Kayser–Fleischer rings 615
Description 615
Condition/s associated with 615
More common 615
Less common 615
Wilson’s disease mechanism/s 615
Primary biliary cirrhosis mechanism/s 616
Sign value 616
Leuconychia 617
Description 617
Condition/s associated with 617
More common 617
Less common 617
Mechanism/s 617
Liver disease 617
Sign value 617
McBurney’s point tenderness (Surgical sign) 619
Description 619
Condition/s associated with 619
Mechanism/s 619
Sign value 619
Melaena 620
Description 620
Condition/s associated with 620
More common 620
Less common 620
Mechanism/s 620
Sign value 620
Mouth ulcers (aphthous ulcer) 621
Description 621
Condition/s associated with 621
More common 621
Less common 621
Mechanism/s 621
Sign value 621
Muehrcke’s lines 622
Description 622
Condition/s associated with 622
Mechanism/s 622
Sign value 622
Murphy’s sign (Surgical sign) 623
Description 623
Condition/s associated with 623
Mechanism/s 623
Sign value 623
Obturator sign (Surgical sign) 624
Description 624
Condition/s associated with 624
Mechanism/s 624
Sign value 624
Oliguria/anuria 626
Description 626
Condition/s associated with 626
Mechanisms/s 626
Pre-renal 626
Renal 626
Post-renal 626
Sign value 627
Palmar erythema 628
Description 628
Condition/s associated with 628
General mechanism/s 628
Pregnancy 628
Chronic liver disease 628
Rheumatoid arthritis 628
Neoplastic 628
Hyperthyroid 629
Sign value 629
Pruritic scratch marks/pruritus 631
Description 631
Condition/s associated with 631
General mechanism/s 631
Chronic renal failure 631
Hepatobiliary 631
Haematopoietic 633
Metabolic and endocrine 633
Neurological disorders 634
Sign value 634
Psoas sign (Surgical sign) 635
Description 635
Condition/s associated with 635
Mechanism/s 635
Sign value 635
Pyoderma gangrenosum 636
Description 636
Condition/s associated with 636
Mechanism/s 636
Sign value 636
Rebound tenderness (Surgical sign) 637
Description 637
Condition/s associated with 637
Mechanism/s 637
Sign value 637
Rigidity and involuntary guarding (Surgical sign) 638
Description 638
Condition/s associated with 638
Mechanism/s 638
Sign value 638
Rovsing’s sign (Surgical sign) 639
Description 639
Condition/s associated with 639
Mechanism/s 639
Sign value 639
Scleral icterus 640
Description 640
Condition/s associated with 640
Mechanism/s 640
Sign value 640
Sialadenosis 641
Description 641
Condition/s associated with 641
Alcoholism mechanism/s 641
Sign value 641
Sister Mary Joseph nodule (Surgical sign) 642
Description 642
Condition/s associated with 642
Mechanism/s 642
Sign value 642
Spider naevus 643
Description 643
Condition/s associated with 643
More common 643
Less common 643
Mechanism/s 643
Sign value 643
Splenomegaly 645
Description 645
Condition/s associated with 645
Mechanism/s 646
Hypertrophy from immunological response 646
Increased red blood cell destruction 646
Congestive engorgement 646
Myeloproliferative disorders 646
Sign value 647
Steatorrhoea 648
Description 648
Condition/s associated with 648
More common 648
Less common 648
Mechanism/s 648
Pancreatic insufficiency (luminal) 648
Cirrhosis and biliary obstruction (luminal) 648
Coeliac disease (mucosal) 648
Lymphatic obstruction (post-absorptive) 649
Striae 650
Description 650
Condition/s associated with 650
Mechanism/s 650
Cushing’s syndrome 650
Sign value 650
Uveitis/iritis 651
Description 651
Condition/s associated with 651
More common 651
Less common 651
General mechanism/s 651
Trauma 651
Infection 651
Non-infectious causes 652
Inflammatory bowel disease 652
References 653
7 Endocrinological Signs 660
Acanthosis nigricans (AN) 661
Description 661
Condition/s associated with 661
More common 661
Less common 661
General mechanism/s 661
Detailed mechanism/s 661
Sign value 663
Angioid streaks 664
Description 664
Condition/s associated with 664
More common 664
Less common 664
Mechanism/s 664
Sign value 664
Atrophic testicles 665
Description 665
Condition/s associated with 665
More common 665
Less common 665
Mechanism/s 665
Klinefelter’s syndrome (47XXY) 665
Prader–Willi syndrome 665
Anabolic steroid use 665
Varicocoele 665
Cirrhosis of the liver 665
Alcohol 665
Sign value 666
Ballotable kidney 667
Description 667
Condition/s associated with 667
More common 667
Less common 667
Mechanism/s 667
Unilateral causes 667
Bilateral causes 667
Sign value 667
Bruising 668
Description 668
Condition/s associated with 668
Mechanism/s 668
Cushing’s syndrome 668
Renal failure with uraemia 668
Chvostek’s sign 670
Description 670
Condition/s associated with 670
More common 670
Less common 670
Mechanism/s 670
Hypocalcaemia 670
Respiratory alkalosis/hyperventilation 670
Hypomagnesaemia 671
Sign value 671
Cushingoid habitus 672
Description 672
Central adiposity 672
Moon facies 672
Buffalo hump 672
Condition/s associated with 672
Central adiposity mechanism/s 672
Sign value 673
Diabetic amyotrophy (lumbar plexopathy) 674
Description 674
Condition/s associated with 674
Mechanism/s 674
Diabetic retinopathy 675
Description 675
Condition/s associated with 675
Mechanism/s 675
Sign value 675
Frontal bossing 679
Description 679
Condition/s associated with 679
More common 679
Less common 679
Mechanism/s 679
Galactorrhoea 680
Description 680
Condition/s associated with 680
General mechanism/s 680
Selected pharmaceutical mechanism/s 681
Prolactinomas 681
Pituitary stalk compression 681
Hypothyroidism 681
Chest wall stimulation 681
Acromegaly 681
Renal failure 682
Newborn galactorrhoea 682
Sign value 682
Goitre 683
Description 683
Condition/s associated with 683
Mechanism/s 683
Sign value 683
Granuloma annulare 685
Description 685
Condition/s associated with 685
More common 685
Less common 685
Mechanism/s 685
Sign value 685
Graves’ ophthalmopathy (orbitopathy) 686
Description 686
Condition/s associated with 686
Mechanism/s 686
Summary of mechanism/s 688
Sign value 688
Hirsutism 691
Description 691
Condition/s associated with 691
More common 691
Less common 691
Mechanism/s 691
Polycystic ovary syndrome 691
Cushing’s syndrome 691
Congenital adrenal hyperplasia 691
Adrenal tumours 691
Sign value 692
Hypercarotinaemia/carotenoderma 693
Description 693
Condition/s associated with 693
More common 693
Less common 693
Mechanism/s 693
Sign value 693
Hyperpigmentation and bronzing 695
Description 695
Haemochromatosis sign 695
Addison’s disease sign 695
Condition/s associated with 695
Mechanism/s 695
Addison’s disease 695
Cushing’s disease 695
Haemochromatosis 696
Sign value 696
Hyperreflexia 698
Description 698
Condition/s associated with 698
Hyperthyroid mechanism/s 698
Hyperthyroid tremor 699
Description 699
Condition/s associated with 699
Mechanism/s 699
Sign value 699
Hyporeflexia/delayed ankle jerks (Woltman’s sign) 700
Description 700
Condition/s associated with 700
Mechanism/s 700
Sign value 700
Hypotension 702
Description 702
Condition/s associated with 702
Mechanism/s 702
Addison’s disease 702
Hypothyroidism 702
Sign value 702
Macroglossia 705
Description 705
Condition/s associated with 705
More common 705
Less common 705
Mechanism/s 705
Beckwith–Wiedemann syndrome 706
Hypothyroidism 706
Amyloidosis 706
Acromegaly 706
Lymphangioma 706
Sign value 706
Necrobiosis lipoidica diabeticorum (NLD) 707
Description 707
Condition/s associated with 707
Mechanism/s 707
Sign value 707
Onycholysis (Plummer’s nail) 708
Description 708
Condition/s associated with 708
More common 708
Less common 708
Mechanism/s 708
Drug related 708
Sign value 708
Pemberton’s sign 709
Description 709
Condition/s associated with 709
Mechanism/s 709
Sign value 710
Periodic paralysis 711
Description 711
Condition/s associated with 711
Mechanism/s 711
Sign value 711
Plethora 712
Description 712
Condition/s associated with 712
More common 712
Less common 712
General mechanism/s 712
Cushing’s disease 712
Carcinoid syndrome 712
Mitral stenosis 713
Parenchymal lung disease 713
Sign value 713
Polydipsia 714
Description 714
Condition/s associated with 714
More common 714
Less common 714
Mechanism/s 714
Sjögren’s syndrome 714
Psychogenic polydipsia 714
Primary hyperaldosteronism 714
Polyuria 715
Description 715
Condition/s associated with 715
More common 715
Less common 715
Mechanism/s 715
Diabetes mellitus 715
Diabetes insipidus 715
Post-obstructive diuresis 715
Lithium 717
Polyuria: Cushing’s syndrome 718
Psychogenic polyuria mechanism/s 718
Pre-tibial myxoedema (thyroid dermopathy) 719
Description 719
Condition/s associated with 719
Mechanism/s 719
Sign value 720
Prognathism 721
Description 721
Condition/s associated with 721
Mechanism/s 721
Sign value 721
Proximal myopathy 722
Description 722
Condition/s associated with 722
More common 722
Less common 722
Mechanism/s 722
Hyperthyroid 722
Hypothyroidism 722
Hyperparathyroidism 722
Cushing’s syndrome 722
Addison’s disease 724
Sign value 724
Skin tags (acrochordon) 725
Description 725
Condition/s associated with 725
Mechanism/s 725
Sign value 725
Steroid acne 726
Description 726
Condition/s associated with 726
More common 726
Less common 726
Mechanism/s 726
Trousseau’s sign 727
Description 727
Condition/s associated with 727
More common 727
Less common 727
Mechanism/s 727
Sign value 727
Uraemic frost 728
Description 728
Condition/s associated with 728
Mechanism/s 728
Sign value 728
Vitiligo 729
Description 729
Condition/s associated with 729
Mechanism/s 729
Sign value 729
Webbed neck (pterygium colli deformity) 731
Description 731
Condition/s associated with 731
Mechanism/s 731
Sign value 731
References 732
Figure Credits 738
Index 745
A 745
B 747
C 748
D 751
E 752
F 752
G 753
H 754
I 755
J 756
K 756
L 756
M 757
N 759
O 759
P 760
Q 763
R 763
S 764
T 766
U 767
V 768
W 768
X 769
Y 769