Additional Information
Book Details
Abstract
2016 BMA Medical Book Awards Highly Commended in the Medicine Category!
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.
- A Student Consult eBook is available with the purchase of a print book, and provides access to a total of 200 multiple choice questions covering the 7 body systems, to test students and trainees’ knowledge of the content.
- The eBook contains links to audio and video examples of particular signs which have to be heard or observed over a period of time in order to be identified correctly, e.g. Agonal respiration in Chapter 2 Respiratory Signs.
- 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 |