Additional Information
Book Details
Abstract
The first consolidated textbook explaining the mechanism of clinical signs commonly seen in medicine. Mechanisms of Clinical Signs is the first consolidated text of its kind; designed to help medical students and junior doctors understand the pathophysiological mechanisms behind clinical signs. Unlike existing clinical examination textbooks which are predominantly organised by disease systems and states, Mechanisms of Clinical Signs is arranged by body system; bridging the gap between identifying clinical signs and understanding the causes behind them. Presented in a useful handbook style, Mechanisms of Clinical Signs discusses the evidence base and clinical value of each clinical sign to assist with interpretation. Examples are plentiful and include such signs as distinctive tremors in a Parkinson’s disease patient and red hands on a patient with liver disease. As well as being an easy-to-follow reference for clinical signs seen on the ward, Mechanisms of Clinical Signs is an excellent study aid – particularly useful for those preparing for ‘Viva’ or ‘OSCE’ practical stations. The ability to accurately identify and interpret clinical signs of disease upon examination is a vital first step in correct diagnosis and treatment. Mechanisms of Clinical Signs is therefore an essential textbook for medical students and new practitioners. Online StudentConsult resources accompany Mechanisms of Clinical Signs upon purchase.
• first consolidated text explaining the mechanism of clinical signs commonly seen in medicine• easy reference guide for clinical signs seen on the ward or during examinations
• a resource for those preparing for “Viva or “OSCE practical stations where students see patients and are asked specific questions relating to the clinical examination
• organised by body system it reviews the common clinical signs seen in diseases by the main system or specialty of medicine in a convenient handbook style
• each chapter contains all the clinical signs, a description of the sign, the disease/s in which the sign appears and an explanation as to the mechanism
• evidence base and clinical value of the sign is discussed to assist interpretation
• Online Student Consult resources accompany the text
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front cover | cover | ||
| Mechanisms of clinical signs | i | ||
| Copyright page | iv | ||
| Table of Contents | v | ||
| Contents by Condition | ix | ||
| Acidotic states – diabetic ketoacidosis | ix | ||
| Acromegaly | ix | ||
| Addison’s disease | ix | ||
| Airway obstruction | ix | ||
| Anaemia and nutrient deficiency | ix | ||
| Ankle/foot signs | ix | ||
| Aortic regurgitation | ix | ||
| Aortic stenosis | ix | ||
| Aphasia | ix | ||
| Atrial septal defect/ventricular septal defect | ix | ||
| Asthma | ix | ||
| Bronchiectasis | ix | ||
| Cardiac tamponade/pericardial effusion | ix | ||
| Cerebellar signs | x | ||
| Chronic renal failure | x | ||
| Congestive heart failure | x | ||
| Chronic obstructive pulmonary disease (COPD) | x | ||
| Cranial nerve signs | x | ||
| Cushing’s syndrome | x | ||
| Cystic fibrosis | x | ||
| Dermatomyositis | x | ||
| Diabetes | x | ||
| Endocarditis | xi | ||
| Gait abnormalities | xi | ||
| Haemochromatosis | xi | ||
| Heart block | xi | ||
| Hip signs | xi | ||
| Hypertension | xi | ||
| Hyperthyroidism | xi | ||
| Hypertrophic obstructive cardiomyopathy | xi | ||
| Hypocalcaemia | xi | ||
| Hypothyroidism | xi | ||
| Hypovolaemia | xi | ||
| Inflammatory bowel disease | xi | ||
| Knee signs | xi | ||
| Left bundle branch block | xi | ||
| Leukaemia/lymphoma | xi | ||
| Liver disease/cirrhosis | xii | ||
| Lung cancer malignancy – primary or secondary | xii | ||
| Malignancy – other | xii | ||
| Mitral regurgitation | xii | ||
| Mitral stenosis | xii | ||
| Osteoarthritis | xii | ||
| Parkinson’s disease | xii | ||
| Patent ductus arteriosis | xii | ||
| Pericarditis/constrictive pericarditis | xii | ||
| Pleural effusion | xii | ||
| Pneumonia | xii | ||
| Pneumothorax | xii | ||
| Power | xiii | ||
| Psoriatic arthritis | xiii | ||
| Pulmonary embolus | xiii | ||
| Pulmonary fibrosis | xiii | ||
| Pulmonary hypertension | xiii | ||
| Pulmonary regurgitation | xiii | ||
| Pulmonary stenosis | xiii | ||
| Reflexes | xiii | ||
| Renal failure | xiii | ||
| Rheumatoid arthritis | xiii | ||
| Right bundle branch block | xiii | ||
| Scleroderma | xiii | ||
| Sensation | xiii | ||
| Sepsis | xiii | ||
| Shoulder signs | xiii | ||
| Systemic lupus erythematosus | xiii | ||
| Solid malignancies | xiii | ||
| Thrombocytopenia | xiv | ||
| Tone | xiv | ||
| Tremor | xiv | ||
| Tricuspid regurgitation | xiv | ||
| Tricuspid stenosis | xiv | ||
| Vision defects/neurological eye signs | xiv | ||
| Foreword | xv | ||
| Preface | xvi | ||
| Acknowledgements | xviii | ||
| Authors | xviii | ||
| Expert Reviewers | xix | ||
| Reviewers | xix | ||
| Abbreviations | xx | ||
| 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 | ||
| Ligament laxity | 5 | ||
| Joint contracture | 5 | ||
| Altered foot mechanics | 5 | ||
| Sign value | 5 | ||
| Apprehension test (crank test) | 6 | ||
| Description | 6 | ||
| Condition/s associated with | 6 | ||
| More common – traumatic | 6 | ||
| Less common – atraumatic | 6 | ||
| Mechanism/s | 6 | ||
| Sign value | 6 | ||
| Apprehension–relocation test (Fowler’s sign) | 7 | ||
| Description | 7 | ||
| Condition/s associated with | 7 | ||
| Mechanism/s | 7 | ||
| Sign value | 7 | ||
| Bouchard’s and Heberden’s nodes | 8 | ||
| Description | 8 | ||
| Condition/s associated with | 8 | ||
| Mechanism/s | 8 | ||
| Sign value | 8 | ||
| Boutonnière deformity | 9 | ||
| Description | 9 | ||
| Condition/s associated with | 9 | ||
| Mechanism/s | 9 | ||
| Trauma | 9 | ||
| Laceration | 9 | ||
| Infection | 9 | ||
| Inflammatory | 9 | ||
| Sign value | 10 | ||
| Bulge/wipe/stroke test | 11 | ||
| Description | 11 | ||
| Condition/s associated with | 11 | ||
| More common | 11 | ||
| Less common | 11 | ||
| Mechanism/s | 11 | ||
| Sign value | 11 | ||
| Butterfly rash (malar rash) | 12 | ||
| Description | 12 | ||
| Condition/s associated with | 12 | ||
| Common | 12 | ||
| Mechanism/s | 12 | ||
| Sign value | 12 | ||
| Calcinosis/calcinosis cutis | 14 | ||
| Description | 14 | ||
| Condition/s associated with | 14 | ||
| General mechanism/s | 14 | ||
| Dystrophic calcinosis | 14 | ||
| Metastatic calcinosis | 14 | ||
| Iatrogenic | 15 | ||
| Idiopathic | 15 | ||
| Sign value | 15 | ||
| Charcot’s foot | 16 | ||
| Description | 16 | ||
| Condition/s associated with | 16 | ||
| Mechanism/s | 16 | ||
| Sign value | 17 | ||
| Crepitus | 18 | ||
| Description | 18 | ||
| Condition/s associated with | 18 | ||
| General mechanism/s | 18 | ||
| Rheumatoid/osteoarthritis | 18 | ||
| Sign value | 18 | ||
| Dropped arm test | 19 | ||
| Description | 19 | ||
| Condition/s associated with | 19 | ||
| Mechanism/s | 19 | ||
| Sign value | 19 | ||
| Finkelstein’s test | 20 | ||
| Description | 20 | ||
| Condition/s associated with | 20 | ||
| Mechanism/s | 20 | ||
| Sign value | 20 | ||
| Gottron’s papules | 21 | ||
| Description | 21 | ||
| Condition/s associated with | 21 | ||
| Mechanism/s | 21 | ||
| Sign value | 21 | ||
| Hawkins’ impingement sign | 22 | ||
| Description | 22 | ||
| Condition/s associated with | 22 | ||
| Mechanism/s | 22 | ||
| Rotator cuff injuries/tendonitis | 23 | ||
| Sign value | 23 | ||
| Heliotrope rash | 24 | ||
| Description | 24 | ||
| Condition/s associated with | 24 | ||
| Mechanism/s | 24 | ||
| Sign value | 24 | ||
| Kyphosis | 25 | ||
| Description | 25 | ||
| Condition/s associated with | 25 | ||
| More common | 25 | ||
| Less common | 25 | ||
| Mechanism/s | 25 | ||
| Degenerative/osteoporotic | 25 | ||
| Congenital kyphosis | 25 | ||
| Scheuerman kyphosis | 25 | ||
| Sign value | 25 | ||
| Lachman’s test/sign | 26 | ||
| Description | 26 | ||
| Condition/s associated with | 26 | ||
| Mechanism/s | 26 | ||
| Sign value | 26 | ||
| Livedo reticularis | 27 | ||
| Description | 27 | ||
| Condition/s associated with | 27 | ||
| More common | 27 | ||
| Less common | 27 | ||
| General mechanism/s | 27 | ||
| Primary or idiopathic LR | 27 | ||
| Elderly | 28 | ||
| Anti-phospholipid syndrome | 28 | ||
| Cryoglobulinaemia | 28 | ||
| Sign value | 28 | ||
| McMurray’s test | 29 | ||
| Description | 29 | ||
| Checking the medial meniscus | 29 | ||
| Checking the lateral meniscus | 29 | ||
| Condition/s associated with | 29 | ||
| Mechanism/s | 29 | ||
| Sign value | 29 | ||
| Neer’s impingement sign | 30 | ||
| Description | 30 | ||
| Condition/s associated with | 30 | ||
| Mechanism/s | 30 | ||
| Sign value | 30 | ||
| Patellar apprehension test | 31 | ||
| Description | 31 | ||
| Condition/s associated with | 31 | ||
| Mechanism/s | 31 | ||
| Sign value | 31 | ||
| Patellar tap | 32 | ||
| Description | 32 | ||
| Condition/s associated with | 32 | ||
| More common | 32 | ||
| Less common | 32 | ||
| Mechanism/s | 32 | ||
| Sign value | 32 | ||
| Patrick’s test (FABER test) | 33 | ||
| Description | 33 | ||
| Condition/s associated with | 33 | ||
| More common | 33 | ||
| Less common | 33 | ||
| Mechanism/s | 33 | ||
| Sign value | 33 | ||
| Phalen’s sign | 34 | ||
| Description | 34 | ||
| Condition/s associated with | 34 | ||
| Mechanism/s | 34 | ||
| Sign value | 34 | ||
| Proximal myopathy | 35 | ||
| Description | 35 | ||
| Condition/s associated with | 35 | ||
| Mechanism/s | 35 | ||
| Inflammatory myopathies | 35 | ||
| Systemic disorders | 35 | ||
| Sign value | 35 | ||
| Psoriatic nails/psoriatic nail dystrophy | 36 | ||
| Description | 36 | ||
| Condition/s associated with | 36 | ||
| Mechanism/s | 36 | ||
| Nail pitting | 36 | ||
| Subungual keratosis | 37 | ||
| Oil drops | 37 | ||
| Salmon patches | 37 | ||
| Splinter haemorrhages | 37 | ||
| Sign value | 37 | ||
| Raynaud’s syndrome/phenomenon | 38 | ||
| Description | 38 | ||
| Condition/s associated with | 38 | ||
| Common | 38 | ||
| Less common | 38 | ||
| Mechanism/s | 39 | ||
| Secondary Raynaud’s | 39 | ||
| Saddle nose deformity | 40 | ||
| Description | 40 | ||
| Condition/s associated with | 40 | ||
| More common | 40 | ||
| Less common | 40 | ||
| Mechanism/s | 40 | ||
| Wegener’s granulomatosis | 40 | ||
| Relapsing polychondritis | 40 | ||
| Sign value | 40 | ||
| Sausage-shaped digits (dactylitis) | 41 | ||
| Description | 41 | ||
| Condition/s associated with | 41 | ||
| More common | 41 | ||
| Uncommon | 41 | ||
| Mechanism/s | 41 | ||
| Spondyloarthritis | 41 | ||
| Tuberculosis dactylitis | 41 | ||
| Syphilitic dactylitis | 41 | ||
| Sarcoid dactylitis | 41 | ||
| Sickle cell dactylitis | 41 | ||
| Sign value | 41 | ||
| Sclerodactyly | 43 | ||
| Description | 43 | ||
| Condition/s associated with | 43 | ||
| Mechanism/s | 43 | ||
| Sign value | 43 | ||
| Shawl sign | 44 | ||
| Description | 44 | ||
| Condition/s associated with | 44 | ||
| Mechanism/s | 44 | ||
| Sign value | 44 | ||
| Simmonds–Thompson test | 45 | ||
| Description | 45 | ||
| Condition/s associated with | 45 | ||
| Mechanism/s | 45 | ||
| Sign value | 45 | ||
| Speed’s test | 46 | ||
| Description | 46 | ||
| Condition/s associated with | 46 | ||
| Mechanism/s | 46 | ||
| Sign value | 46 | ||
| Subcutaneous nodules (rheumatoid nodules) | 47 | ||
| Description | 47 | ||
| Condition/s associated with | 47 | ||
| Mechanism/s | 47 | ||
| Sign value | 47 | ||
| Sulcus sign | 48 | ||
| Description | 48 | ||
| Condition/s associated with | 48 | ||
| Mechanism/s | 48 | ||
| Sign value | 48 | ||
| Supraspinatus test (empty can test) | 49 | ||
| Description | 49 | ||
| Condition/s associated with | 49 | ||
| Mechanism/s | 49 | ||
| Sign value | 49 | ||
| Swan-neck deformity | 50 | ||
| Description | 50 | ||
| Condition/s associated with | 50 | ||
| Common | 50 | ||
| Uncommon | 50 | ||
| Mechanism/s | 50 | ||
| Sign value | 51 | ||
| Telangiectasia | 52 | ||
| Description | 52 | ||
| Condition/s associated with | 52 | ||
| General mechanism/s | 52 | ||
| Hereditary haemorrhagic telangiectasia (HHT) | 52 | ||
| Scleroderma | 53 | ||
| Sign value | 53 | ||
| Thomas’ test | 54 | ||
| Description | 54 | ||
| Condition/s associated with | 54 | ||
| Mechanism/s | 54 | ||
| Sign value | 54 | ||
| Tinel’s sign | 55 | ||
| Description | 55 | ||
| Condition/s associated with | 55 | ||
| Mechanism/s | 55 | ||
| Sign value | 55 | ||
| Trendelenburg’s sign | 56 | ||
| Description | 56 | ||
| Condition/s associated with | 56 | ||
| Mechanism/s | 56 | ||
| Sign value | 56 | ||
| True leg length discrepancy (anatomic leg length discrepancy) | 57 | ||
| Description | 57 | ||
| Condition/s associated with | 57 | ||
| Mechanism/s | 57 | ||
| Sign value | 57 | ||
| Ulnar deviation | 58 | ||
| Description | 58 | ||
| Condition/s associated with | 58 | ||
| Mechanism/s | 58 | ||
| Metacarpophalangeal (MCP) joint | 58 | ||
| Radiocarpal ulnar deviation | 58 | ||
| Sign value | 58 | ||
| V-sign | 59 | ||
| Description | 59 | ||
| Condition/s associated with | 59 | ||
| Mechanism/s | 59 | ||
| Sign value | 59 | ||
| Valgus deformity | 60 | ||
| Description | 60 | ||
| Condition/s associated with | 60 | ||
| Mechanism/s | 60 | ||
| Hallux valgus | 60 | ||
| Knee valgus (genu valgum) | 61 | ||
| Sign value | 61 | ||
| Varus deformity | 63 | ||
| Description | 63 | ||
| Condition/s associated with | 63 | ||
| Mechanism/s | 63 | ||
| Coxa vara | 64 | ||
| Congenital | 63 | ||
| Rickets | 63 | ||
| Perthes’ disease | 64 | ||
| Genu varum | 64 | ||
| Blount’s disease | 64 | ||
| Hallux varus | 64 | ||
| Sign value | 64 | ||
| Yergason’s sign | 65 | ||
| Description | 65 | ||
| Condition/s associated with | 65 | ||
| Mechanism/s | 65 | ||
| Rotator cuff and impingement | 65 | ||
| Sign value | 66 | ||
| References | 67 | ||
| 2 Respiratory Signs | 71 | ||
| Accessory muscle breathing | 73 | ||
| Description | 73 | ||
| Condition/s associated with | 73 | ||
| Mechanism/s | 73 | ||
| Sign value | 73 | ||
| Agonal respiration | 74 | ||
| Description | 74 | ||
| Condition/s associated with | 74 | ||
| Mechanism/s | 74 | ||
| Sign value | 74 | ||
| Apneustic breathing (also apneusis) | 75 | ||
| Description | 75 | ||
| Condition/s associated with | 75 | ||
| Mechanism/s | 75 | ||
| Sign value | 75 | ||
| Apnoea | 76 | ||
| Description | 76 | ||
| Condition/s associated with | 76 | ||
| Central sleep apnoea (CSA) | 76 | ||
| Obstructive sleep apnoea (OSA) | 76 | ||
| Mechanism/s | 76 | ||
| Central sleep apnoea | 76 | ||
| Obstructive sleep apnoea | 76 | ||
| Sign value | 77 | ||
| Asterixis | 78 | ||
| Description | 78 | ||
| Condition/s associated with | 78 | ||
| More common | 78 | ||
| Less common | 78 | ||
| Mechanism/s | 78 | ||
| Sign value | 78 | ||
| Asymmetrical chest expansion | 79 | ||
| Description | 79 | ||
| Condition/s associated with | 79 | ||
| More common | 79 | ||
| Less common | 79 | ||
| Mechanism/s | 79 | ||
| Pneumonia, pleural effusions | 79 | ||
| Foreign body | 79 | ||
| Flail segment | 79 | ||
| Kyphoscoliosis | 79 | ||
| Unilateral diaphragm paralysis | 80 | ||
| Sign value | 80 | ||
| Asynchronous respiration | 81 | ||
| Description | 81 | ||
| Condition/s associated with | 81 | ||
| Mechanism/s | 81 | ||
| Sign value | 81 | ||
| Ataxic (Biot’s) breathing | 82 | ||
| Description | 82 | ||
| Condition/s associated with | 82 | ||
| More common | 82 | ||
| Less common | 82 | ||
| Mechanism/s | 82 | ||
| Sign value | 82 | ||
| Barrel chest | 83 | ||
| Description | 83 | ||
| Condition/s associated with | 83 | ||
| Mechanism/s | 83 | ||
| Bradypnoea | 84 | ||
| Description | 84 | ||
| Condition/s associated with | 84 | ||
| More common | 84 | ||
| Less common | 84 | ||
| Mechanism/s | 84 | ||
| Sign value | 84 | ||
| Bronchial breath sounds | 85 | ||
| Description | 85 | ||
| Condition/s associated with | 85 | ||
| Mechanism/s | 85 | ||
| Sign value | 85 | ||
| Cough reflex | 86 | ||
| Description | 86 | ||
| Condition/s associated with | 86 | ||
| More common | 86 | ||
| Less common | 86 | ||
| Mechanism/s | 86 | ||
| Sign value | 87 | ||
| Character of cough | 87 | ||
| Crackles (rales) | 88 | ||
| Description | 88 | ||
| Condition/s associated with | 88 | ||
| Mechanism/s | 88 | ||
| Sign value | 88 | ||
| Dyspnoea | 89 | ||
| Description | 89 | ||
| Condition/s associated with | 89 | ||
| General mechanism/s | 89 | ||
| Common pathways | 89 | ||
| Mechanical loading, respiratory effort and ‘corollary discharge’ | 89 | ||
| Chemoreceptors | 89 | ||
| Mechanoreceptors | 90 | ||
| Neurochemical dissociation | 90 | ||
| Deconditioning | 90 | ||
| COPD | 90 | ||
| Anaemia | 90 | ||
| Heart failure | 90 | ||
| Asthma | 91 | ||
| Neuromuscular disorders | 91 | ||
| Sign value | 91 | ||
| Funnel chest (pectus excavatum) | 92 | ||
| Description | 92 | ||
| Condition/s associated with | 92 | ||
| Mechanism/s | 92 | ||
| Sign value | 92 | ||
| Grunting | 93 | ||
| Description | 93 | ||
| Condition/s associated with | 93 | ||
| More common | 93 | ||
| Less common | 93 | ||
| Mechanism/s | 93 | ||
| Sign value | 93 | ||
| Haemoptysis | 94 | ||
| Description | 94 | ||
| Condition/s associated with | 94 | ||
| More common | 94 | ||
| Less common | 94 | ||
| Mechanism/s | 94 | ||
| Cancer | 94 | ||
| Pulmonary venous hypertension | 94 | ||
| Infection | 94 | ||
| Sign value | 94 | ||
| Harrison’s sulcus (also Harrison’s groove) | 95 | ||
| Description | 95 | ||
| Condition/s associated with | 95 | ||
| Mechanism/s | 95 | ||
| Hoover’s sign | 96 | ||
| Description | 96 | ||
| Condition/s associated with | 96 | ||
| Mechanism/s | 96 | ||
| Sign value | 96 | ||
| Hypertrophic pulmonary osteoarthropathy (HPOA) | 97 | ||
| Description | 97 | ||
| Condition/s associated with | 97 | ||
| More common | 97 | ||
| Less common | 97 | ||
| Mechanism/s | 97 | ||
| Lung cancer | 97 | ||
| Sign value | 97 | ||
| Hyperventilation | 98 | ||
| Description | 98 | ||
| Condition/s associated with | 98 | ||
| Mechanism/s | 98 | ||
| Psychiatric | 98 | ||
| Organic causes | 99 | ||
| Respiratory disease | 99 | ||
| Pulmonary embolism | 99 | ||
| CNS disorders | 99 | ||
| Physiological causes | 99 | ||
| Metabolic acidosis | 99 | ||
| Pregnancy | 99 | ||
| Intercostal recession | 100 | ||
| Description | 100 | ||
| Condition/s associated with | 100 | ||
| Common | 100 | ||
| Mechanism/s | 100 | ||
| Sign value | 100 | ||
| Kussmaul’s breathing | 101 | ||
| Description | 101 | ||
| Condition/s associated with | 101 | ||
| More common | 101 | ||
| Less common | 101 | ||
| Mechanism/s | 101 | ||
| Sign value | 101 | ||
| Orthopnoea | 102 | ||
| Description | 102 | ||
| Condition/s associated with | 102 | ||
| Congestive heart failure mechanism/s | 102 | ||
| Sign value | 103 | ||
| Paradoxical abdominal movements (also abdominal paradox) | 104 | ||
| Description | 104 | ||
| Condition/s associated with | 104 | ||
| Mechanism/s | 104 | ||
| Sign value | 104 | ||
| Paradoxical respiration/breathing | 105 | ||
| Description | 105 | ||
| Condition/s associated with | 105 | ||
| Mechanism/s | 105 | ||
| Sign value | 105 | ||
| Paroxysmal nocturnal dyspnoea (PND) | 106 | ||
| Description | 106 | ||
| Condition/s associated with | 106 | ||
| Mechanism/s | 106 | ||
| Sign value | 106 | ||
| Percussion | 107 | ||
| Topographic percussion theory | 107 | ||
| Cage resonance theory | 107 | ||
| Percussion: dullness | 108 | ||
| Description | 108 | ||
| Condition/s associated with | 108 | ||
| Mechanism/s | 108 | ||
| Sign value | 108 | ||
| Percussion: resonance/hyper-resonance | 109 | ||
| Description | 109 | ||
| Condition/s associated with | 109 | ||
| Mechanism/s | 109 | ||
| Sign value | 109 | ||
| Periodic breathing | 110 | ||
| Description | 110 | ||
| Condition/s associated with | 110 | ||
| Mechanism/s | 110 | ||
| Sign value | 110 | ||
| Pigeon chest (pectus carinatum) | 111 | ||
| Description | 111 | ||
| Condition/s associated with | 111 | ||
| More common | 111 | ||
| Less common | 111 | ||
| Mechanism/s | 111 | ||
| Sign value | 111 | ||
| Platypnoea | 112 | ||
| Description | 112 | ||
| Condition/s associated with | 112 | ||
| General mechanism/s | 112 | ||
| Patent foramen ovale | 112 | ||
| Pneumonectomy | 112 | ||
| Pulmonary | 112 | ||
| Hepatic | 112 | ||
| Sign value | 112 | ||
| Pleural friction rub | 114 | ||
| Description | 114 | ||
| Condition/s associated with | 114 | ||
| More common | 114 | ||
| Less common | 114 | ||
| Mechanism/s | 114 | ||
| Pursed lips breathing | 115 | ||
| Description | 115 | ||
| Condition/s associated with | 115 | ||
| Mechanism/s | 115 | ||
| Sign value | 115 | ||
| Sputum | 116 | ||
| Description | 116 | ||
| Condition/s associated with | 116 | ||
| Mechanism/s | 116 | ||
| Sign value | 116 | ||
| Stertor | 117 | ||
| Description | 117 | ||
| Condition/s associated with | 117 | ||
| Mechanism/s | 117 | ||
| Stridor | 118 | ||
| Description | 118 | ||
| Condition/s associated with | 118 | ||
| More common | 118 | ||
| Less common | 118 | ||
| Mechanism/s | 118 | ||
| Characteristics of stridor | 118 | ||
| Sign value | 118 | ||
| Subcutaneous emphysema/surgical emphysema | 119 | ||
| Description | 119 | ||
| Condition/s associated with | 119 | ||
| Mechanism/s | 119 | ||
| Sign value | 119 | ||
| Tachypnoea | 120 | ||
| Description | 120 | ||
| Condition/s associated with | 120 | ||
| Mechanism/s | 120 | ||
| Sign value | 120 | ||
| Tracheal tug | 121 | ||
| Description | 121 | ||
| Condition/s associated with | 121 | ||
| Most common | 121 | ||
| Less common | 121 | ||
| Mechanism/s | 121 | ||
| Tracheal tug – Campbell’s sign | 121 | ||
| Tracheal tug – Oliver’s sign | 121 | ||
| Sign value | 121 | ||
| Trepopnoea | 122 | ||
| Description | 122 | ||
| Condition/s associated with | 122 | ||
| Mechanism/s | 122 | ||
| Unilateral lung disease | 122 | ||
| Congestive heart failure | 122 | ||
| Lung tumour | 122 | ||
| Sign value | 122 | ||
| Vesicular breath sounds | 123 | ||
| Description | 123 | ||
| Condition/s associated with | 123 | ||
| Mechanism/s | 123 | ||
| Vocal fremitus/tactile fremitus | 124 | ||
| Description | 124 | ||
| Condition/s associated with | 124 | ||
| Mechanism/s | 124 | ||
| Sign value | 124 | ||
| Vocal resonance | 125 | ||
| Description | 125 | ||
| Condition/s associated with | 125 | ||
| Mechanism/s | 125 | ||
| Sign value | 125 | ||
| Wheeze | 126 | ||
| Description | 126 | ||
| Condition/s associated with | 126 | ||
| Mechanism/s | 126 | ||
| Sign value | 126 | ||
| References | 127 | ||
| 3 Cardiovascular Signs | 131 | ||
| Apex beat (also cardiac impulse) | 132 | ||
| Description | 132 | ||
| Apex beat: displaced | 133 | ||
| Description | 133 | ||
| Condition/s associated with | 133 | ||
| More common | 133 | ||
| Less common | 133 | ||
| Mechanism/s | 133 | ||
| Sign value | 133 | ||
| Apex beat: hyperdynamic apical impulse/volume-loaded | 134 | ||
| Description | 134 | ||
| Condition/s associated with | 134 | ||
| More common | 134 | ||
| Less common | 134 | ||
| Mechanism/s | 134 | ||
| Sign value | 134 | ||
| Apex beat: left ventricular heave/sustained apical impulse/pressure-loaded apex | 135 | ||
| Description | 135 | ||
| Condition/s associated with | 135 | ||
| More common | 135 | ||
| Less common | 135 | ||
| Mechanism/s | 135 | ||
| Sign value | 135 | ||
| Arterial pulse | 136 | ||
| Arterial pulse: anacrotic | 138 | ||
| Description | 138 | ||
| Condition/s associated with | 138 | ||
| Mechanism/s | 138 | ||
| Arterial pulse: bigeminal | 139 | ||
| Definition | 139 | ||
| Condition/s associated with | 139 | ||
| Mechanism/s | 139 | ||
| Arterial pulse: dicrotic | 140 | ||
| Description | 140 | ||
| Condition/s associated with | 140 | ||
| Mechanism/s | 140 | ||
| Sign value | 140 | ||
| Arterial pulse: pulsus alternans | 141 | ||
| Description | 141 | ||
| Condition/s associated with | 141 | ||
| Mechanism/s | 141 | ||
| Sign value | 141 | ||
| Arterial pulse: pulsus bisferiens | 142 | ||
| Description | 142 | ||
| Condition/s associated with | 142 | ||
| More common | 142 | ||
| Less common | 142 | ||
| General mechanism/s | 142 | ||
| Hypertrophic cardiomyopathy | 142 | ||
| Sign value | 142 | ||
| Arterial pulse: pulsus parvus | 143 | ||
| Description | 143 | ||
| Condition/s associated with | 143 | ||
| Mechanism/s | 143 | ||
| Sign value | 143 | ||
| Arterial pulse: pulsus tardus | 144 | ||
| Description | 144 | ||
| Condition/s associated with | 144 | ||
| Mechanism/s | 144 | ||
| Sign value | 144 | ||
| Arterial pulse: sinus arrhythmia | 145 | ||
| Description | 145 | ||
| Condition/s associated with | 145 | ||
| Mechanism/s | 145 | ||
| Sign value | 145 | ||
| Bradycardia | 146 | ||
| Description | 146 | ||
| Condition/s associated with | 146 | ||
| More common | 146 | ||
| Less common | 146 | ||
| Mechanism/s | 146 | ||
| Myocardial infarction | 146 | ||
| Cellular hypoxia | 146 | ||
| Sinus node disease | 146 | ||
| Heart block | 146 | ||
| Electrolyte imbalances | 146 | ||
| Haemochromatosis | 146 | ||
| Drugs | 146 | ||
| Sign value | 146 | ||
| Buerger’s sign | 147 | ||
| Description | 147 | ||
| Condition/s associated with | 147 | ||
| Mechanism/s | 147 | ||
| Sign value | 147 | ||
| Cardiac cachexia | 148 | ||
| Description | 148 | ||
| Condition/s associated with | 148 | ||
| Mechanism/s | 148 | ||
| Sign value | 148 | ||
| Carotid bruit | 149 | ||
| Description | 149 | ||
| Condition/s associated with | 149 | ||
| More common | 149 | ||
| Less common | 149 | ||
| Mechanism/s | 149 | ||
| Sign value | 149 | ||
| Cheyne–Stokes breathing | 150 | ||
| Description | 150 | ||
| Condition/s associated with | 150 | ||
| More common | 150 | ||
| Less common | 150 | ||
| Mechanism/s | 151 | ||
| Mechanism/s in congestive heart failure | 151 | ||
| Sign value | 151 | ||
| Clubbing | 152 | ||
| Description | 152 | ||
| Condition/s associated with | 152 | ||
| Mechanism/s | 152 | ||
| Sign value | 153 | ||
| Crackles (also rales) | 154 | ||
| Description | 154 | ||
| Condition/s associated with | 154 | ||
| More common | 154 | ||
| Mechanism/s | 154 | ||
| Heart failure | 154 | ||
| Pulmonary oedema | 154 | ||
| Sign value | 154 | ||
| Cyanosis | 155 | ||
| Cyanosis: central | 156 | ||
| Description | 156 | ||
| Condition/s associated with | 156 | ||
| More common | 156 | ||
| Less common | 156 | ||
| Mechanism/s | 156 | ||
| Cardiac | 156 | ||
| Respiratory | 156 | ||
| Cyanosis: peripheral | 157 | ||
| Description | 157 | ||
| Condition/s associated with | 157 | ||
| Common | 157 | ||
| Less common | 157 | ||
| Mechanism/s | 157 | ||
| Ewart’s sign | 158 | ||
| Description | 158 | ||
| Condition/s associated with | 158 | ||
| Mechanism/s | 158 | ||
| Hepatojugular reflux (also abdominojugular reflux) | 159 | ||
| Description | 159 | ||
| Condition/s associated with | 159 | ||
| Mechanism/s | 159 | ||
| Sign value | 159 | ||
| Hepatomegaly | 160 | ||
| Description | 160 | ||
| Condition/s associated with | 160 | ||
| Mechanism/s | 160 | ||
| Hypertensive retinopathy | 161 | ||
| Sign value | 161 | ||
| Hypertensive retinopathy: arteriovenous (AV) nipping (or AV nicking) | 162 | ||
| Description | 162 | ||
| Condition/s associated with | 162 | ||
| Mechanism/s | 162 | ||
| Hypertensive retinopathy: copper and silver wiring | 163 | ||
| Description | 163 | ||
| Condition/s associated with | 163 | ||
| Mechanism/s | 163 | ||
| Hypertensive retinopathy: cotton wool spots | 164 | ||
| Description | 164 | ||
| Condition/s associated with | 164 | ||
| More common | 164 | ||
| Less common | 164 | ||
| Mechanism/s | 164 | ||
| Hypertensive retinopathy: microaneurysms | 165 | ||
| Description | 165 | ||
| Condition/s associated with | 165 | ||
| Mechanism/s | 165 | ||
| Hypertensive retinopathy: retinal haemorrhage | 166 | ||
| Description | 166 | ||
| Condition/s associated with | 166 | ||
| More common | 166 | ||
| Less common | 166 | ||
| Mechanism/s | 166 | ||
| Janeway lesions | 167 | ||
| Definition | 167 | ||
| Condition/s associated with | 167 | ||
| Mechanism/s | 167 | ||
| Sign value | 167 | ||
| Jugular venous pressure (JVP) | 168 | ||
| JVP: Kussmaul’s sign | 169 | ||
| Description | 169 | ||
| Condition/s associated with | 169 | ||
| More common | 169 | ||
| Less common | 169 | ||
| Mechanism/s | 169 | ||
| Sign value | 169 | ||
| JVP: raised | 170 | ||
| Description | 170 | ||
| Condition/s associated with | 170 | ||
| Mechanism/s | 170 | ||
| Sign value | 170 | ||
| JVP: the normal waveform | 171 | ||
| JVP waveform variations: a-waves – cannon | 172 | ||
| Description | 172 | ||
| Condition/s associated with | 172 | ||
| More common | 172 | ||
| Less common | 172 | ||
| Mechanism/s | 172 | ||
| JVP waveform variations: a-waves – prominent or giant | 173 | ||
| Description | 173 | ||
| Condition/s associated with | 173 | ||
| Mechanism/s | 173 | ||
| JVP waveform variations: v-waves – large | 174 | ||
| Description | 174 | ||
| Condition/s associated with | 174 | ||
| Mechanism/s | 174 | ||
| Sign value | 174 | ||
| JVP waveform variations: x-descent – absent | 175 | ||
| Description | 175 | ||
| Condition/s associated with | 175 | ||
| Mechanism/s | 175 | ||
| JVP waveform variations: x-descent – prominent | 176 | ||
| Description | 176 | ||
| Condition/s associated with | 176 | ||
| Mechanism/s | 176 | ||
| Sign value | 176 | ||
| JVP waveform variations: y-descent – absent | 177 | ||
| Description | 177 | ||
| Condition/s associated with | 177 | ||
| Most common | 177 | ||
| Less common | 177 | ||
| Mechanism/s | 177 | ||
| JVP waveform variations: y-descent – prominent (Friedrich’s sign) | 179 | ||
| Description | 179 | ||
| Condition/s associated with | 179 | ||
| More common | 179 | ||
| Less common | 179 | ||
| Mechanism/s | 179 | ||
| Sign value | 179 | ||
| Mid-systolic click | 180 | ||
| Description | 180 | ||
| Condition/s associated with | 180 | ||
| Mechanism/s | 180 | ||
| Sign value | 180 | ||
| Mitral facies | 181 | ||
| Description | 181 | ||
| Condition/s associated with | 181 | ||
| Mechanism/s | 181 | ||
| Murmurs | 182 | ||
| Murmurs – systolic: aortic stenotic murmur | 183 | ||
| Description | 183 | ||
| Condition/s associated with | 183 | ||
| Mechanism/s | 183 | ||
| Age-related degeneration (‘senile calcification’) | 183 | ||
| Rheumatic heart disease | 184 | ||
| Sign value | 184 | ||
| Murmurs – systolic: mitral regurgitation murmur | 185 | ||
| Description | 185 | ||
| Condition/s associated with | 185 | ||
| More common causes | 185 | ||
| General mechanism/s | 185 | ||
| Rheumatic heart disease | 185 | ||
| Infective endocarditis | 185 | ||
| Cardiomyopathy | 185 | ||
| Ischaemic heart disease | 185 | ||
| Myxomatous degeneration | 185 | ||
| Sign value | 186 | ||
| Murmurs – systolic: pulmonary stenotic murmur | 187 | ||
| Description | 187 | ||
| Condition/s associated with | 187 | ||
| Mechanism/s | 187 | ||
| Congenital | 187 | ||
| Carcinoid syndrome | 187 | ||
| Murmurs – systolic: tricuspid regurgitation murmur (also Carvello’s sign) | 188 | ||
| Description | 188 | ||
| Condition/s associated with | 188 | ||
| More common | 188 | ||
| Less common | 188 | ||
| General mechanism/s | 188 | ||
| Right ventricular dilatation | 189 | ||
| Carcinoid syndrome | 189 | ||
| Connective tissue disease | 189 | ||
| Rheumatic fever | 189 | ||
| Sign value | 189 | ||
| Murmurs – systolic: ventricular septal defect murmur | 190 | ||
| Description | 190 | ||
| Condition/s associated with | 190 | ||
| Mechanism/s | 190 | ||
| Sign value | 190 | ||
| Murmurs – diastolic: aortic regurgitation murmur | 191 | ||
| Description | 191 | ||
| Condition/s associated with | 191 | ||
| More common | 191 | ||
| Less common | 191 | ||
| Mechanism/s | 191 | ||
| Sign value | 191 | ||
| Murmurs – diastolic: eponymous signs of aortic regurgitation | 192 | ||
| Murmurs – diastolic: Graham Steell murmur | 195 | ||
| Description | 195 | ||
| Condition/s associated with | 195 | ||
| Mechanism/s | 195 | ||
| Murmurs – diastolic: mitral stenotic murmur | 196 | ||
| Description | 196 | ||
| Condition/s associated with | 196 | ||
| Mechanism/s | 196 | ||
| Sign value | 196 | ||
| Murmurs – diastolic: opening snap (OS) | 197 | ||
| Description | 197 | ||
| Condition/s associated with | 197 | ||
| Mechanism/s | 197 | ||
| Sign value | 197 | ||
| Murmurs – diastolic: pulmonary regurgitation murmur | 198 | ||
| Description | 198 | ||
| Condition/s associated with | 198 | ||
| More common | 198 | ||
| Less common | 198 | ||
| Mechanism/s | 198 | ||
| Sign value | 198 | ||
| Murmurs – diastolic: tricuspid stenotic murmur | 199 | ||
| Description | 199 | ||
| Condition/s associated with | 199 | ||
| More common | 199 | ||
| Less common | 199 | ||
| Mechanism/s | 199 | ||
| Murmurs – continuous: patent ductus arteriosus murmur | 200 | ||
| Description | 200 | ||
| Condition/s associated with | 200 | ||
| Mechanism/s | 200 | ||
| Osler’s nodes | 201 | ||
| Definition | 201 | ||
| Condition/s associated with | 201 | ||
| More common | 201 | ||
| Less common | 201 | ||
| Mechanism/s | 201 | ||
| Sign value | 201 | ||
| Pericardial knock | 202 | ||
| Description | 202 | ||
| Condition/s associated with | 202 | ||
| Mechanism/s | 202 | ||
| Sign value | 202 | ||
| Pericardial rub | 203 | ||
| Description | 203 | ||
| Condition/s associated with | 203 | ||
| Mechanism/s | 203 | ||
| Peripheral oedema | 204 | ||
| Definition | 204 | ||
| Condition/s associated with | 204 | ||
| More common | 204 | ||
| Less common | 204 | ||
| Mechanism/s | 204 | ||
| Mechanism in heart failure | 204 | ||
| Liver disease | 204 | ||
| Nephrotic syndrome | 204 | ||
| Sign value | 206 | ||
| Pulse pressure | 207 | ||
| Pulse pressure: narrow | 208 | ||
| Description | 208 | ||
| Condition/s associated with | 208 | ||
| Common | 208 | ||
| Less common | 208 | ||
| Mechanism/s | 208 | ||
| Cardiac failure | 208 | ||
| Shock | 208 | ||
| Pulse pressure: widened | 209 | ||
| Description | 209 | ||
| Condition/s associated with | 209 | ||
| Most common | 209 | ||
| Mechanism/s | 209 | ||
| Old age | 209 | ||
| Septic shock | 209 | ||
| Aortic regurgitation | 209 | ||
| Hyperthyroidism | 209 | ||
| Sign value | 209 | ||
| Pulsus paradoxus | 212 | ||
| Description | 212 | ||
| Condition/s associated with | 212 | ||
| More common | 212 | ||
| Less common | 212 | ||
| General mechanism/s | 212 | ||
| Cardiac tamponade | 212 | ||
| Massive pulmonary embolism | 212 | ||
| Respiratory disorders | 213 | ||
| Sign value | 213 | ||
| Radial–radial delay | 215 | ||
| Description | 215 | ||
| Condition/s associated with | 215 | ||
| Mechanism/s | 215 | ||
| Radio-femoral delay | 216 | ||
| Description | 216 | ||
| Condition/s associated with | 216 | ||
| Mechanism/s | 216 | ||
| Right ventricular heave | 217 | ||
| Description | 217 | ||
| Condition/s associated with | 217 | ||
| More common | 217 | ||
| Less common | 217 | ||
| General mechanism/s | 217 | ||
| Mitral regurgitation | 217 | ||
| Roth’s spots | 218 | ||
| Description | 218 | ||
| Condition/s associated with | 218 | ||
| More common | 218 | ||
| Less common | 218 | ||
| Mechanism/s | 218 | ||
| Sign value | 218 | ||
| S1 (first heart sound): accentuated | 220 | ||
| Description | 220 | ||
| Condition/s associated with | 220 | ||
| Mechanism/s | 220 | ||
| Shortened PR interval | 220 | ||
| Mild mitral stenosis | 220 | ||
| High cardiac output states | 220 | ||
| Sign value | 220 | ||
| S1 (first heart sound): diminished | 221 | ||
| Description | 221 | ||
| Condition/s associated with | 221 | ||
| Mechanism/s | 221 | ||
| Lengthened PR interval | 221 | ||
| Mitral regurgitation | 221 | ||
| Severe mitral stenosis | 221 | ||
| Left ventricle with reduced compliance | 221 | ||
| S3 (third heart sound) | 222 | ||
| Description | 222 | ||
| Condition/s associated with | 222 | ||
| More common | 222 | ||
| Less common | 222 | ||
| Mechanism/s | 222 | ||
| Sign value | 222 | ||
| S4 (fourth heart sound) | 223 | ||
| Description | 223 | ||
| Condition/s associated with | 223 | ||
| Common | 223 | ||
| Less common | 223 | ||
| Mechanism/s | 223 | ||
| Sign value | 223 | ||
| Splinter haemorrhages | 224 | ||
| Description | 224 | ||
| Condition/s associated with | 224 | ||
| Mechanism/s | 224 | ||
| Sign value | 224 | ||
| Splitting heart sounds | 225 | ||
| Splitting heart sounds: paradoxical (reverse) splitting | 226 | ||
| Description | 226 | ||
| Condition/s associated with | 226 | ||
| Mechanism/s | 226 | ||
| Aortic stenosis | 226 | ||
| LBBB | 226 | ||
| Sign value | 226 | ||
| Splitting heart sounds: physiological splitting | 227 | ||
| Description | 227 | ||
| Condition/s associated with | 227 | ||
| Mechanism/s | 227 | ||
| Splitting heart sounds: widened splitting | 228 | ||
| Description | 228 | ||
| Condition/s associated with | 228 | ||
| Mechanism/s | 228 | ||
| Pulmonary stenosis | 228 | ||
| Right bundle branch block (RBBB) | 228 | ||
| Splitting heart sounds: widened splitting – fixed | 229 | ||
| Description | 229 | ||
| Condition/s associated with | 229 | ||
| Mechanism/s | 229 | ||
| Sign value | 229 | ||
| Tachycardia (sinus) | 230 | ||
| Description | 230 | ||
| Condition/s associated with | 230 | ||
| More common | 230 | ||
| Less common | 230 | ||
| Mechanism/s | 230 | ||
| Mechanism in hyperthyroidism | 230 | ||
| Sign value | 230 | ||
| Xanthelasmata | 231 | ||
| Description | 231 | ||
| Condition/s associated with | 231 | ||
| Mechanism/s | 231 | ||
| Hyperlipidaemic | 231 | ||
| Normolipidaemic | 231 | ||
| Sign value | 231 | ||
| References | 232 | ||
| 4 Haematological/Oncological Signs | 237 | ||
| Angular stomatitis | 238 | ||
| Description | 238 | ||
| Condition/s associated with | 238 | ||
| More common | 238 | ||
| Less common | 238 | ||
| Nutritional deficiency mechanism/s | 238 | ||
| Sign value | 238 | ||
| Atrophic glossitis | 239 | ||
| Description | 239 | ||
| Condition/s associated with | 239 | ||
| More common | 239 | ||
| Less common | 239 | ||
| Mechanism/s | 239 | ||
| Sign value | 239 | ||
| Bone tenderness/bone pain | 240 | ||
| Description | 240 | ||
| Condition/s associated with | 240 | ||
| More common | 240 | ||
| General mechanism/s | 240 | ||
| Complication of direct malignant invasion | 240 | ||
| Malignancy-induced osteoclast/osteoblast imbalance | 240 | ||
| Alteration of normal pain pathways | 241 | ||
| Sign value | 241 | ||
| Chipmunk facies | 242 | ||
| Description | 242 | ||
| Condition/s associated with | 242 | ||
| Beta thalassaemia mechanism/s | 242 | ||
| Conjunctival pallor | 243 | ||
| Description | 243 | ||
| Condition/s associated with | 243 | ||
| Mechanism/s | 243 | ||
| Sign value | 243 | ||
| Ecchymoses, purpura and petechiae | 244 | ||
| Description | 244 | ||
| General mechanism/s | 244 | ||
| Thrombocytopenia | 244 | ||
| Vasculitis | 245 | ||
| Cushing’s | 245 | ||
| Mechanism of colour changes | 245 | ||
| Sign value | 245 | ||
| Gum hypertrophy (gingival hyperplasia) | 246 | ||
| Description | 246 | ||
| Condition/s associated with | 246 | ||
| Leukaemia mechanism/s | 246 | ||
| Drug-induced mechanism/s | 246 | ||
| Sign value | 246 | ||
| Haemolytic/pre-hepatic jaundice | 247 | ||
| Description | 247 | ||
| Condition/s associated with | 247 | ||
| General mechanism/s | 247 | ||
| Destruction | 247 | ||
| Sign value | 248 | ||
| Koilonychia | 249 | ||
| Description | 249 | ||
| Condition/s associated with | 249 | ||
| More common | 249 | ||
| Less common | 249 | ||
| Mechanism/s | 249 | ||
| Sign value | 249 | ||
| Leser–Trélat sign | 250 | ||
| Description | 250 | ||
| Condition/s associated with | 250 | ||
| More common | 250 | ||
| Less common | 250 | ||
| Mechanism/s | 250 | ||
| Sign value | 250 | ||
| Leucoplakia | 251 | ||
| Description | 251 | ||
| Condition/s associated with | 251 | ||
| Mechanism/s | 251 | ||
| Sign value | 251 | ||
| Lymphadenopathy | 252 | ||
| Description | 252 | ||
| Condition/s associated with | 252 | ||
| General mechanism/s | 252 | ||
| Malignancy | 252 | ||
| Infectious | 252 | ||
| Autoimmune | 253 | ||
| Sign value | 253 | ||
| Painful versus painless nodes | 253 | ||
| Neoplastic fever | 255 | ||
| Description | 255 | ||
| Condition/s associated with | 255 | ||
| Mechanism/s | 255 | ||
| Sign value | 255 | ||
| Peau d’orange | 256 | ||
| Description | 257 | ||
| Condition/s associated with | 257 | ||
| More common | 257 | ||
| Less common | 257 | ||
| General mechanism/s | 257 | ||
| Breast cancer | 257 | ||
| Sign value | 257 | ||
| Prostate (abnormal) | 258 | ||
| Description | 258 | ||
| Condition/s associated with | 258 | ||
| Prostate cancer mechanism/s | 258 | ||
| Prostatitis mechanism/s | 258 | ||
| Prostate cancer screening | 258 | ||
| Rectal mass | 259 | ||
| Description | 259 | ||
| Condition/s associated with | 259 | ||
| Colorectal cancer screening | 259 | ||
| Trousseau’s sign of malignancy | 260 | ||
| Description | 260 | ||
| Condition/s associated with | 260 | ||
| More common | 260 | ||
| Less common | 260 | ||
| Mechanism/s | 260 | ||
| Tissue factor | 260 | ||
| Carcinoma mucins | 260 | ||
| Oncogene activation | 261 | ||
| Tissue hypoxia | 261 | ||
| Sign value | 261 | ||
| References | 262 | ||
| 5 Neurological Signs | 265 | ||
| Guide to the ‘Relevant neuroanatomy and topographical anatomy’ boxes | 266 | ||
| Abducens nerve (CNVI) palsy | 267 | ||
| Description | 267 | ||
| Condition/s associated with | 267 | ||
| Common | 267 | ||
| Less common | 267 | ||
| Mechanism/s | 267 | ||
| Disorders of the subarachnoid space | 268 | ||
| Diabetic mononeuropathy and microvascular infarction | 268 | ||
| Elevated intracranial pressure, the ‘false localising sign’ | 268 | ||
| Cavernous carotid artery aneurysm and cavernous sinus syndrome | 270 | ||
| Orbital apex syndrome | 270 | ||
| Sign value | 270 | ||
| Anisocoria | 271 | ||
| Description | 271 | ||
| Condition/s associated with | 271 | ||
| Common | 271 | ||
| Less common | 271 | ||
| Mechanism/s | 271 | ||
| Mechanism – anisocoria more prominent in the dark | 273 | ||
| Horner’s syndrome | 273 | ||
| Pupillary constrictor muscle spasm | 273 | ||
| Drugs | 273 | ||
| Mechanism – anisocoria more prominent in bright light | 273 | ||
| Oculomotor nerve (CNIII) palsy | 273 | ||
| Adie’s tonic pupil | 274 | ||
| Damage to the neuromuscular structures of the iris | 274 | ||
| Drugs | 274 | ||
| Sign value | 275 | ||
| Anosmia | 276 | ||
| Description | 276 | ||
| Condition/s associated with | 276 | ||
| Common | 276 | ||
| Less common | 276 | ||
| Mechanism/s | 276 | ||
| Olfactory cleft obstruction | 276 | ||
| Inflammatory disorders of the olfactory neuroepithelium | 277 | ||
| Traumatic injury of the olfactory nerves | 277 | ||
| Olfactory bulb or tract lesion | 277 | ||
| Neurodegenerative disease of the cerebral cortex | 277 | ||
| Normal ageing | 277 | ||
| Sign value | 277 | ||
| Argyll Robertson pupils and light–near dissociation | 278 | ||
| Description | 278 | ||
| Condition/s associated with | 278 | ||
| Mechanism/s | 278 | ||
| Sign value | 279 | ||
| Ataxic gait | 280 | ||
| Description | 280 | ||
| Condition/s associated with | 280 | ||
| Common | 280 | ||
| Less common | 280 | ||
| Mechanism/s | 280 | ||
| Cerebellar vermis lesion | 280 | ||
| Flocculonodular lobe lesion | 281 | ||
| Intermediate hemisphere lesion | 281 | ||
| Lateral hemisphere lesion | 281 | ||
| Sign value | 281 | ||
| Atrophy (muscle wasting) | 282 | ||
| Description | 282 | ||
| Condition/s associated with | 283 | ||
| Common | 283 | ||
| Less common | 283 | ||
| Mechanism/s | 283 | ||
| Lower motor neuron disorders | 283 | ||
| Disuse atrophy | 283 | ||
| Upper motor neuron disorders | 283 | ||
| Myopathy | 283 | ||
| Peripheral vascular disease | 283 | ||
| Sign value | 283 | ||
| Babinski response | 285 | ||
| Description | 285 | ||
| Condition/s associated with | 285 | ||
| Common | 285 | ||
| Less common | 285 | ||
| Mechanism/s | 285 | ||
| Sign value | 286 | ||
| Bradykinesia | 287 | ||
| Description | 287 | ||
| Condition/s associated with | 287 | ||
| Common | 287 | ||
| Less common | 287 | ||
| Mechanism/s | 287 | ||
| Parkinson’s disease and the Parkinson’s plus syndromes | 287 | ||
| Dopamine antagonists | 288 | ||
| Sign value | 288 | ||
| Broca’s aphasia (expressive aphasia) | 289 | ||
| Description | 289 | ||
| Condition/s associated with | 289 | ||
| Common | 289 | ||
| Less common | 289 | ||
| Mechanism/s | 289 | ||
| Sign value | 289 | ||
| Brown-Séquard syndrome | 291 | ||
| Description | 291 | ||
| Condition/s associated with | 292 | ||
| Common | 292 | ||
| Less common | 292 | ||
| Mechanism/s | 292 | ||
| Sign value | 292 | ||
| Cavernous sinus syndrome | 293 | ||
| Description | 293 | ||
| Condition/s associated with | 293 | ||
| Common | 293 | ||
| Less common | 293 | ||
| Mechanism/s | 293 | ||
| Septic thrombosis | 293 | ||
| Aseptic thrombosis | 294 | ||
| Cavernous internal carotid artery aneurysm | 294 | ||
| Pituitary apoplexy | 294 | ||
| Disorders of the sphenoid and ethmoid sinuses | 294 | ||
| Sign value | 295 | ||
| Clasp-knife phenomenon | 296 | ||
| Description | 296 | ||
| Condition/s associated with | 296 | ||
| Common | 296 | ||
| Less common | 296 | ||
| Mechanism/s | 296 | ||
| Sign value | 296 | ||
| Clonus | 297 | ||
| Description | 297 | ||
| Condition/s associated with | 297 | ||
| Common | 297 | ||
| Less common | 297 | ||
| Mechanism/s | 297 | ||
| Upper motor neuron lesion | 297 | ||
| Serotonin syndrome | 297 | ||
| Sign value | 297 | ||
| Cogwheel rigidity | 298 | ||
| Description | 298 | ||
| Condition/s associated with | 298 | ||
| Common | 298 | ||
| Less common | 298 | ||
| Mechanism/s | 298 | ||
| Sign value | 298 | ||
| Corneal reflex | 299 | ||
| Description | 299 | ||
| Condition/s associated with | 300 | ||
| Common | 300 | ||
| Less common | 300 | ||
| Mechanism/s | 300 | ||
| Facial nerve palsy | 300 | ||
| Disorders of the ophthalmic division of the trigeminal nerve (CNV V1) | 300 | ||
| Disorders of the cornea | 301 | ||
| Sign value | 301 | ||
| Crossed-adductor reflex | 302 | ||
| Description | 302 | ||
| Condition/s associated with | 302 | ||
| Common | 302 | ||
| Less common | 302 | ||
| Mechanism/s | 302 | ||
| Sign value | 302 | ||
| Dysarthria | 303 | ||
| Description | 303 | ||
| Condition/s associated with | 303 | ||
| Common | 303 | ||
| Less common | 303 | ||
| Mechanism/s | 303 | ||
| Disorders of the cerebellum | 303 | ||
| Disorders of the oral cavity and oropharynx | 303 | ||
| Disorders of the upper motor neuron | 303 | ||
| Disorders of the lower motor neuron | 304 | ||
| Sign value | 304 | ||
| Dysdiadochokinesis | 305 | ||
| Description | 305 | ||
| Condition/s associated with | 305 | ||
| Common | 305 | ||
| Less common | 305 | ||
| Mechanism/s | 305 | ||
| Sign value | 306 | ||
| Dysmetria | 307 | ||
| Description | 307 | ||
| Condition/s associated with | 307 | ||
| Common | 307 | ||
| Less common | 308 | ||
| Mechanism/s | 308 | ||
| Sign value | 308 | ||
| Dysphonia | 309 | ||
| Description | 309 | ||
| Condition/s associated with | 309 | ||
| Common | 309 | ||
| Less common | 309 | ||
| Mechanism/s | 309 | ||
| Local disorders of the vocal cords and larynx | 310 | ||
| Disorders of glossopharyngeal nerve, vagus nerve and recurrent laryngeal nerve | 310 | ||
| Disorders of the brainstem | 310 | ||
| Sign value | 310 | ||
| Essential tremor | 311 | ||
| Description | 311 | ||
| Condition/s associated with | 311 | ||
| Common | 311 | ||
| Less common | 311 | ||
| Mechanism/s | 311 | ||
| Sign value | 311 | ||
| Facial muscle weakness (unilateral) | 312 | ||
| Description | 312 | ||
| Condition/s associated with | 314 | ||
| Upper motor neuron | 314 | ||
| 6 Gastroenterological Signs | 443 | ||
| Ascites | 444 | ||
| Description | 444 | ||
| Condition/s associated with | 444 | ||
| Mechanism/s | 444 | ||
| Peripheral arterial vasodilatation theory | 444 | ||
| Congestive heart failure, nephrotic syndrome, Budd–Chiari syndrome and myxoedema | 444 | ||
| Exudative ascites | 445 | ||
| Chylous ascites | 445 | ||
| Nephrogenic – haemodialysis | 445 | ||
| Ascites clinical signs | 445 | ||
| Sign value | 445 | ||
| Asterixis (also hepatic flap) | 447 | ||
| Description | 447 | ||
| Condition/s associated with | 447 | ||
| Hepatic mechanism/s | 447 | ||
| Sign value | 447 | ||
| Bowel sounds | 448 | ||
| Sign value | 448 | ||
| Bowel sounds: absent | 449 | ||
| Description | 449 | ||
| Condition/s associated with | 449 | ||
| More common | 449 | ||
| Less common | 449 | ||
| General mechanism/s | 449 | ||
| Bowel obstruction | 449 | ||
| Infection | 449 | ||
| Postoperative ileus | 449 | ||
| Hypokalaemia | 449 | ||
| Pseudo-obstruction | 449 | ||
| Bowel sounds: hyperactive (borborygmus) | 450 | ||
| Description | 450 | ||
| Condition/s associated with: | 450 | ||
| More common | 450 | ||
| Less common | 450 | ||
| Mechanism/s | 450 | ||
| Bowel sounds: tinkling | 451 | ||
| Description | 451 | ||
| Condition/s associated with | 451 | ||
| Mechanism/s | 451 | ||
| Sign value | 451 | ||
| Caput medusae | 452 | ||
| Description | 452 | ||
| Condition/s associated with | 452 | ||
| Mechanism/s | 452 | ||
| Sign value | 452 | ||
| Cheilitis granulomatosa | 454 | ||
| Description | 454 | ||
| Condition/s associated with | 454 | ||
| Mechanism/s | 454 | ||
| Sign value | 454 | ||
| Coffee ground vomiting/bloody vomitus/haematemesis | 455 | ||
| Description | 455 | ||
| Condition/s associated with | 455 | ||
| More common | 455 | ||
| Less common | 455 | ||
| General mechanism/s | 455 | ||
| Peptic ulcer disease | 455 | ||
| Mallory–Weiss tear | 455 | ||
| Oesophageal varices | 455 | ||
| Sign value | 456 | ||
| Courvoisier’s sign | 457 | ||
| Description | 457 | ||
| Condition/s associated with | 457 | ||
| Mechanism/s | 457 | ||
| Sign value | 457 | ||
| Cullen’s sign | 458 | ||
| Description | 458 | ||
| Condition/s associated with | 458 | ||
| More common | 458 | ||
| Less common | 458 | ||
| Mechanism/s | 458 | ||
| Sign value | 458 | ||
| Erythema nodosum | 459 | ||
| Description | 459 | ||
| Condition/s associated with | 459 | ||
| More common | 459 | ||
| Mechanism/s | 459 | ||
| Sign value | 459 | ||
| Grey Turner’s sign | 460 | ||
| Description | 460 | ||
| Condition/s associated with | 460 | ||
| Mechanism/s | 460 | ||
| Sign value | 460 | ||
| Guarding | 461 | ||
| Description | 461 | ||
| Condition/s associated with | 461 | ||
| Mechanism/s | 461 | ||
| Sign value | 461 | ||
| Gynaecomastia | 462 | ||
| Description | 462 | ||
| Condition/s associated with | 462 | ||
| More common | 462 | ||
| Less common | 462 | ||
| General mechanism/s | 462 | ||
| Physiological gynaecomastia | 462 | ||
| Drugs | 462 | ||
| Hepatic cirrhosis | 463 | ||
| Hyperthyroidism | 463 | ||
| Hypogonadism | 463 | ||
| Re-feeding syndrome | 463 | ||
| Renal failure and dialysis | 463 | ||
| Testicular tumours | 463 | ||
| Sign value | 463 | ||
| Hepatic encephalopathy | 465 | ||
| Description | 465 | ||
| Condition/s associated with | 465 | ||
| Mechanism/s | 465 | ||
| Ammonia hypothesis | 465 | ||
| GABA-ergic hypothesis | 466 | ||
| Benzodiazepine hypothesis | 466 | ||
| Manganese hypothesis | 466 | ||
| TNF-α – a unifying theory? | 466 | ||
| Sign value | 466 | ||
| Hepatic foetor | 467 | ||
| Description | 467 | ||
| Condition/s associated with | 467 | ||
| Mechanism/s | 467 | ||
| Sign value | 467 | ||
| Hepatic venous hum | 468 | ||
| Description | 468 | ||
| Condition/s associated with | 468 | ||
| Mechanism/s | 468 | ||
| Hepatomegaly | 469 | ||
| Description | 469 | ||
| Condition/s associated with | 469 | ||
| Mechanism/s | 469 | ||
| Congestive heart failure | 469 | ||
| Infective | 469 | ||
| Infiltrative | 469 | ||
| Sign value | 469 | ||
| Jaundice | 470 | ||
| Description | 470 | ||
| Condition/s associated with | 470 | ||
| Mechanism/s | 470 | ||
| Pre-hepatic | 470 | ||
| Intrahepatic | 470 | ||
| Post-hepatic | 470 | ||
| Kayser–Fleischer rings | 473 | ||
| Description | 473 | ||
| Condition/s associated with | 473 | ||
| More common | 473 | ||
| Less common | 473 | ||
| Wilson’s disease mechanism/s | 473 | ||
| Primary biliary cirrhosis mechanism/s | 474 | ||
| Sign value | 474 | ||
| Leuconychia | 475 | ||
| Description | 475 | ||
| Condition/s associated with | 475 | ||
| More common | 475 | ||
| Less common | 475 | ||
| Mechanism/s | 475 | ||
| Liver disease | 475 | ||
| Sign value | 475 | ||
| Melaena | 476 | ||
| Description | 476 | ||
| Condition/s associated with | 476 | ||
| More common | 476 | ||
| Less common | 476 | ||
| Mechanism/s | 476 | ||
| Sign value | 476 | ||
| Mouth ulcers (aphthous ulcer) | 477 | ||
| Description | 477 | ||
| Condition/s associated with | 477 | ||
| More common | 477 | ||
| Less common | 477 | ||
| Mechanism/s | 477 | ||
| Sign value | 477 | ||
| Muehrcke’s lines | 478 | ||
| Description | 478 | ||
| Condition/s associated with | 478 | ||
| Mechanism/s | 478 | ||
| Sign value | 478 | ||
| Murphy’s sign | 479 | ||
| Description | 479 | ||
| Condition/s associated with | 479 | ||
| Mechanism/s | 479 | ||
| Sign value | 479 | ||
| Obturator sign | 480 | ||
| Description | 480 | ||
| Condition/s associated with | 480 | ||
| Mechanism/s | 480 | ||
| Sign value | 480 | ||
| Palmar erythema | 482 | ||
| Description | 482 | ||
| Condition/s associated with | 482 | ||
| General mechanism/s | 482 | ||
| Pregnancy | 482 | ||
| Chronic liver disease | 483 | ||
| Rheumatoid arthritis | 483 | ||
| Neoplastic | 483 | ||
| Hyperthyroid | 483 | ||
| Sign value | 483 | ||
| Pruritic scratch marks/pruritus | 484 | ||
| Description | 484 | ||
| Condition/s associated with | 484 | ||
| General mechanism/s | 484 | ||
| Chronic renal failure | 484 | ||
| Hepatobiliary | 484 | ||
| Haematopoieic | 485 | ||
| Metabolic and endocrine | 485 | ||
| Neurological disorders | 485 | ||
| Sign value | 485 | ||
| Psoas sign | 487 | ||
| Description | 487 | ||
| Condition/s associated with | 487 | ||
| Mechanism/s | 487 | ||
| Sign value | 487 | ||
| Pyoderma gangrenosum | 488 | ||
| Description | 488 | ||
| Condition/s associated with | 488 | ||
| Mechanism/s | 488 | ||
| Sign value | 488 | ||
| Rebound tenderness | 489 | ||
| Description | 489 | ||
| Condition/s associated with | 489 | ||
| Mechanism/s | 489 | ||
| Sign value | 489 | ||
| Rigidity and involuntary guarding | 490 | ||
| Description | 490 | ||
| Condition/s associated with | 490 | ||
| Mechanism/s | 490 | ||
| Sign value | 490 | ||
| Rovsing’s sign | 491 | ||
| Description | 491 | ||
| Condition/s associated with | 491 | ||
| Mechanism/s | 491 | ||
| Sign value | 491 | ||
| Scleral icterus | 492 | ||
| Description | 492 | ||
| Condition/s associated with | 492 | ||
| Mechanism/s | 492 | ||
| Sign value | 492 | ||
| Sialadenosis | 493 | ||
| Description | 493 | ||
| Condition/s associated with | 493 | ||
| Alcoholism mechanism/s | 493 | ||
| Sign value | 493 | ||
| Sister Mary Joseph nodule | 494 | ||
| Description | 494 | ||
| Condition/s associated with | 494 | ||
| Mechanism/s | 494 | ||
| Sign value | 494 | ||
| Spider naevus | 495 | ||
| Description | 495 | ||
| Condition/s associated with | 495 | ||
| More common | 495 | ||
| Less common | 495 | ||
| Mechanism/s | 495 | ||
| Sign value | 495 | ||
| Splenomegaly | 496 | ||
| Description | 496 | ||
| Condition/s associated with | 496 | ||
| Mechanism/s | 496 | ||
| Hypertrophy from immunological response | 496 | ||
| Increased red blood cell destruction | 496 | ||
| Congestive engorgement | 496 | ||
| Myeloproliferative disorders | 496 | ||
| Sign value | 496 | ||
| Steatorrhoea | 498 | ||
| Description | 498 | ||
| Condition/s associated with | 498 | ||
| More common | 498 | ||
| Less common | 498 | ||
| Mechanism/s | 498 | ||
| Pancreatic insufficiency (luminal) | 498 | ||
| Cirrhosis and biliary obstruction (luminal) | 498 | ||
| Coeliac disease (mucosal) | 498 | ||
| Lymphatic obstruction (post-absorptive) | 498 | ||
| Striae | 499 | ||
| Description | 499 | ||
| Condition/s associated with | 499 | ||
| Mechanism/s | 499 | ||
| Cushing’s syndrome | 499 | ||
| Uveitis/iritis | 500 | ||
| Description | 500 | ||
| Condition/s associated with | 500 | ||
| More common | 500 | ||
| Less common | 500 | ||
| General mechanism/s | 500 | ||
| Trauma | 500 | ||
| Infection | 500 | ||
| Inflammatory bowel disease | 500 | ||
| References | 501 | ||
| 7 Endocrinological Signs | 505 | ||
| Acanthosis nigricans (AN) | 506 | ||
| Description | 506 | ||
| Condition/s associated with | 506 | ||
| More common | 506 | ||
| Less common | 506 | ||
| General mechanism/s | 506 | ||
| Detailed mechanism/s | 506 | ||
| Sign value | 507 | ||
| Angioid streaks | 508 | ||
| Description | 508 | ||
| Condition/s associated with | 508 | ||
| More common | 508 | ||
| Less common | 508 | ||
| Mechanism/s | 508 | ||
| Sign value | 508 | ||
| Atrophic testicles | 509 | ||
| Description | 509 | ||
| Condition/s associated with | 509 | ||
| More common | 509 | ||
| Less common | 509 | ||
| Mechanism/s | 509 | ||
| Klinefelter’s syndrome (47XXY) | 509 | ||
| Prader–Willi syndrome | 509 | ||
| Anabolic steroid use | 509 | ||
| Varicocoele | 509 | ||
| Cirrhosis of the liver | 509 | ||
| Alcohol | 509 | ||
| Sign value | 509 | ||
| Ballotable kidney | 510 | ||
| Description | 510 | ||
| Condition/s associated with | 510 | ||
| More common | 510 | ||
| Less common | 510 | ||
| Mechanism/s | 510 | ||
| Sign value | 510 | ||
| Bruising | 511 | ||
| Description | 511 | ||
| Condition/s associated with | 511 | ||
| Mechanism/s | 511 | ||
| Cushing’s syndrome | 511 | ||
| Uraemia | 511 | ||
| Chvostek’s sign | 513 | ||
| Description | 513 | ||
| Condition/s associated with | 513 | ||
| More common | 513 | ||
| Less common | 513 | ||
| Mechanism/s | 513 | ||
| Hypocalcaemia | 513 | ||
| Respiratory alkalosis/hyperventilation | 513 | ||
| Hypomagnesaemia | 513 | ||
| Sign value | 514 | ||
| Cushing body habitus | 515 | ||
| Description | 515 | ||
| Central adiposity | 515 | ||
| Moon facies | 515 | ||
| Buffalo hump | 515 | ||
| Condition/s associated with | 515 | ||
| Central adiposity mechanism/s | 515 | ||
| Sign value | 515 | ||
| Diabetic amyotrophy (lumbar plexopathy) | 516 | ||
| Description | 516 | ||
| Condition/s associated with | 516 | ||
| Mechanism/s | 516 | ||
| Diabetic retinopathy | 517 | ||
| Description | 517 | ||
| Condition/s associated with | 517 | ||
| Mechanism/s | 517 | ||
| Sign value | 517 | ||
| Frontal bossing | 520 | ||
| Description | 520 | ||
| Condition/s associated with | 520 | ||
| More common | 520 | ||
| Less common | 520 | ||
| Mechanism/s | 520 | ||
| Galactorrhoea | 521 | ||
| Description | 521 | ||
| Condition/s associated with | 521 | ||
| General mechanism/s | 521 | ||
| Selected drug mechanism/s | 522 | ||
| Prolactinomas | 522 | ||
| Pituitary stalk compression | 522 | ||
| Hypothyroidism | 522 | ||
| Chest wall stimulation | 522 | ||
| Acromegaly | 522 | ||
| Renal failure | 522 | ||
| Newborn galactorrhoea | 522 | ||
| Sign value | 522 | ||
| Goitre | 523 | ||
| Description | 523 | ||
| Condition/s associated with | 523 | ||
| Mechanism/s | 523 | ||
| Sign value | 523 | ||
| Granuloma annulare | 525 | ||
| Description | 525 | ||
| Condition/s associated with | 525 | ||
| More common | 525 | ||
| Less common | 525 | ||
| Mechanism/s | 525 | ||
| Sign value | 525 | ||
| Graves’ ophthalmopathy (orbitopathy) | 526 | ||
| Description | 526 | ||
| Condition/s associated with | 526 | ||
| Mechanism/s | 526 | ||
| Summary of eye sign mechanism/s | 526 | ||
| Sign value | 527 | ||
| Graves’ orbitopathy | 530 | ||
| Hirsutism | 531 | ||
| Description | 531 | ||
| Condition/s associated with | 531 | ||
| More common | 531 | ||
| Less common | 531 | ||
| Mechanism/s | 531 | ||
| Polycystic ovary syndrome | 531 | ||
| Cushing’s syndrome | 531 | ||
| Congenital adrenal hyperplasia | 531 | ||
| Adrenal tumours | 531 | ||
| Sign value | 531 | ||
| Hypercarotinaemia/carotenoderma | 532 | ||
| Description | 532 | ||
| Condition/s associated with | 532 | ||
| More common | 532 | ||
| Less common | 532 | ||
| Mechanism/s | 532 | ||
| Sign value | 532 | ||
| Hyperpigmentation and bronzing | 533 | ||
| Description | 533 | ||
| Haemochromatosis description | 533 | ||
| Addison’s disease description | 533 | ||
| Condition/s associated with | 533 | ||
| Mechanism/s | 533 | ||
| Addison’s disease | 533 | ||
| Cushing’s disease | 534 | ||
| Haemochromatosis | 534 | ||
| Sign value | 534 | ||
| Hyperreflexia | 535 | ||
| Description | 535 | ||
| Condition/s associated with | 535 | ||
| Hyperthyroid mechanism/s | 535 | ||
| Hyperthyroid tremor | 536 | ||
| Description | 536 | ||
| Condition/s associated with | 536 | ||
| Mechanism/s | 536 | ||
| Sign value | 536 | ||
| Hyporeflexia/delayed ankle jerks (Woltman’s sign) | 537 | ||
| Description | 537 | ||
| Condition/s associated with | 537 | ||
| Mechanism/s | 537 | ||
| Sign value | 537 | ||
| Hypotension | 538 | ||
| Description | 538 | ||
| Condition/s associated with | 538 | ||
| Mechanism/s | 538 | ||
| Addison’s disease | 538 | ||
| Sign value | 538 | ||
| Macroglossia | 539 | ||
| Description | 539 | ||
| Condition/s associated with | 539 | ||
| More common | 539 | ||
| Less common | 539 | ||
| Mechanism/s | 539 | ||
| Beckwith–Wiedemann syndrome | 539 | ||
| Hypothyroidism | 540 | ||
| Amyloidosis | 540 | ||
| Acromegaly | 540 | ||
| Lymphangioma | 540 | ||
| Sign value | 540 | ||
| Necrobiosis lipoidica diabeticorum (NLD) | 541 | ||
| Description | 541 | ||
| Condition/s associated with | 541 | ||
| Mechanism/s | 541 | ||
| Sign value | 541 | ||
| Onycholysis (Plummer’s nail) | 542 | ||
| Description | 542 | ||
| Condition/s associated with | 542 | ||
| More common | 542 | ||
| Less common | 542 | ||
| Mechanism/s | 542 | ||
| Sign value | 542 | ||
| Pemberton’s sign | 543 | ||
| Description | 543 | ||
| Condition/s associated with | 543 | ||
| Mechanism/s | 543 | ||
| Sign value | 543 | ||
| Periodic paralysis | 544 | ||
| Description | 544 | ||
| Condition/s associated with | 544 | ||
| Mechanism/s | 544 | ||
| Sign value | 544 | ||
| Plethora | 545 | ||
| Description | 545 | ||
| Condition/s associated with | 545 | ||
| More common | 545 | ||
| Less common | 545 | ||
| General mechanism/s | 545 | ||
| Cushing’s disease | 545 | ||
| Carcinoid syndrome | 545 | ||
| Mitral stenosis | 545 | ||
| Parenchymal lung disease | 545 | ||
| Sign value | 545 | ||
| Polydipsia | 546 | ||
| Description | 546 | ||
| Condition/s associated with | 546 | ||
| More common | 546 | ||
| Less common | 546 | ||
| Mechanism/s | 546 | ||
| Sjögren’s syndrome | 546 | ||
| Psychogenic polydipsia | 546 | ||
| Primary hyperaldosteronism | 546 | ||
| Polyuria | 547 | ||
| Description | 547 | ||
| Condition/s associated with | 547 | ||
| More common | 547 | ||
| Less common | 547 | ||
| Mechanism/s | 547 | ||
| Diabetes mellitus | 547 | ||
| Diabetes insipidus | 547 | ||
| Post obstructive diuresis | 547 | ||
| Lithium | 547 | ||
| Polyuria: Cushing’s syndrome | 549 | ||
| Psychogenic polyuria mechanism/s | 549 | ||
| Pre-tibial myxoedema (thyroid dermopathy) | 550 | ||
| Description | 550 | ||
| Condition/s associated with | 550 | ||
| Mechanism/s | 550 | ||
| Sign value | 550 | ||
| Prognathism | 551 | ||
| Description | 551 | ||
| Condition/s associated with | 551 | ||
| Mechanism/s | 551 | ||
| Sign value | 551 | ||
| Proximal myopathy | 552 | ||
| Description | 552 | ||
| Condition/s associated with | 552 | ||
| More common | 552 | ||
| Less common | 552 | ||
| Mechanism/s | 552 | ||
| Hyperthyroid | 552 | ||
| Hypothyroidism | 552 | ||
| Hyperparathyroidism | 552 | ||
| Cushing’s syndrome | 552 | ||
| Sign value | 552 | ||
| Skin tags (acrochordon) | 553 | ||
| Description | 553 | ||
| Condition/s associated with | 553 | ||
| Mechanism/s | 553 | ||
| Sign value | 553 | ||
| Steroid acne | 554 | ||
| Description | 554 | ||
| Condition/s associated with | 554 | ||
| More common | 554 | ||
| Less common | 554 | ||
| Mechanism/s | 554 | ||
| Trousseau’s sign | 555 | ||
| Description | 555 | ||
| Condition/s associated with | 555 | ||
| More common | 555 | ||
| Less common | 555 | ||
| Mechanism/s | 555 | ||
| Sign value | 555 | ||
| Uraemic frost | 556 | ||
| Description | 556 | ||
| Condition/s associated with | 556 | ||
| Mechanism/s | 556 | ||
| Sign value | 556 | ||
| Vitiligo | 557 | ||
| Description | 557 | ||
| Condition/s associated with | 557 | ||
| Mechanism/s | 557 | ||
| Sign value | 557 | ||
| Webbed neck (pterygium colli deformity) | 558 | ||
| Description | 558 | ||
| Condition/s associated with | 558 | ||
| Mechanism/s | 558 | ||
| Sign value | 558 | ||
| References | 559 | ||
| Picture Credits | 563 | ||
| Index | 569 | ||
| A | 569 | ||
| B | 570 | ||
| C | 571 | ||
| D | 573 | ||
| E | 574 | ||
| F | 574 | ||
| G | 574 | ||
| H | 575 | ||
| I | 576 | ||
| J | 576 | ||
| K | 577 | ||
| L | 577 | ||
| M | 577 | ||
| N | 578 | ||
| O | 579 | ||
| P | 579 | ||
| Q | 581 | ||
| R | 581 | ||
| S | 582 | ||
| T | 583 | ||
| U | 584 | ||
| V | 584 | ||
| W | 584 | ||
| X | 585 | ||
| Y | 585 |