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Digestive System and Abdomen DIGESTIVE SYSTEM AND ABDOMEN DIGESTIVE SYSTEM Goodsall's Rule Softening of the vaginal part of the cervix during the first trimester Rare condition when pain occurs due to transposition of a loop of large intestine (usually Chilaiditi transverse colon) in between the diaphragm and the liver, visible on plain abdominal X-ray or chest Syndrome X-ray INTUSSUSCEPTION Dance's Sign Empty RLQ (retracted right iliac fossa) APPENDICITIS Aaron's Sign Epigastric pain with pressure on McBurney's point GI TRACT Dunphy Sign Increase in abdominal pain on coughing Markle Sign RLQ pain on dropping from standing on toes to heels 2/3 of the way lateral on a line from umbilicus to anterior superior iliac spine (corresponds to Mc Burney’s Point junction of vermiform appendix and cecum) Tenderness in the right lower quadrant increases when the patient moves from the supine position Rosenstein's Sign to a recumbent posture on the left side Rovsing's Sign Palpation of LLQ elicits pain in RLQ Sherren's Triangle Area of hyperaesthesia over the right lower abdomen Hampton's Line Line on barium meal indicating mucosal oedema associated with ulcer LIVER Councilman Body eosinophilic globules in liver An inclusion found in the cytoplasm of liver cells. Mallory bodies are damaged intermediate Mallory Body filaments within the hepatocytes BILIARY Boas' Sign Dermal hyperaesthesia at inferior angle of R scapula Courvoisier's Law Palpable gall bladder w/ painless jaundice unlikely to be cholelithiasis ACCESSORY Charcot's Jaundice, fever and chills, RUQ pain Cholangitis Triad/ Reynolds' Pentad Charcot's triad + hypotension and altered mental state CHOLECYSTITIS Murphy's Sign Hesitation on inspiration while gall bladder is palpated Positive when effleurage (light percussion) with crooked third finger at the point of the gallbladder Lépine's Sign projection to anterior abdominal wall (Kerr's point) elicits pain Nardi Test Administration of morphine and neostigmine reproduces sharp LUQ pain; not in general use ABDOMINO PELVIC PERITONEU Blumberg Sign Rebound tenderness M Rigler's Sign Gas outlines both mucosal and serosal surfaces of bowel Howship– Pain from an obturator hernia radiating to knee Romberg Sign HERNIA Hannington-Kiff Absent thigh adductor reflex with positive patellar reflex Sign Anterior abdominal mass which does not cross the midline and is still palpable when abdominal Fothergill's Sign OTHER wall muscles are tensed Carnett's Sign Supine patient lifts head from bed;↑ pain – abdominal wall ;↓ pain – intraperitoneal ABDOMINAL SPLEEN/LUQ Ballance's Sign Percussive dullness left flank, LUQ, percussive resonance right flank Traube's Sign Dull percussion sound over Traube's space Placing the patient in the supine position. With the patient in full inspiration and then full expiration, percuss the area of the lowest intercostal space (eighth or ninth) in the left anterior axillary line. If the note changes from resonant on full expiration to dull on full inspiration, the sign is regarded as positive. The resonant note GENERAL Castell's Sign heard upon full expiration is likely to be due to the air-filled stomach or splenic flexure of the colon. When the patient inspires, the spleen moves inferiorly along the posterolateral abdominal wall. If the spleen is enlarged enough that the inferior pole reaches the eighth or ninth intercostal space, a dull percussion note will be appreciated, indicating splenomegaly. HEMORRHAGE Cullen's Sign Ecchymosis around umbilicus predicts onset of acute pancreatitis Grey Turner's Sign Flank ecchymosis CIRCULATORY SYSTEM HEART DISEASE SYSTOLIC HEART MURMUR: BENIGN PAEDIATRIC HEART MURMUR Still's murmur systolic ejection sound ; vibratory/musical; best heard at left lower sternal border DIASTOLIC HEART MURMUR: PULMONIC REGURGITATION ( Graham Steell murmur) pulmonary regurgitation murmur in patients with pulmonary hypertension secondary to mitral stenosis HEART AORTIC INSUFFICIENCY MURMUR (Austin Flint murmur) mid-diastolic rumble carey coombs murmur MITRAL REGURGITATION (Presystolic murmur) Watson's water hammer bounding forceful pulse elicited with postural manoeuvres pulse/ Corrigan pulse carotid pulsations with abrupt ascending and descending phases De Musset's sign head nodding in time with heartbeat AORTIC Duroziez's sign double bruit heard over femoral artery when it is compressed distally (see Traube's sign) INSUFFICIENCY Müller's sign visible pulsation or bobbing of uvula Quincke's sign visible pulsation in ungual capillary bed Austin Flint murmur mid-diastolic rumble heard at apex Mayne's sign systolic blood pressure drop of >15mmHg on raising arm ENDOCARDITIS: Roth's spot retinal haemorrhages with pale centres seen at fundoscopy ENDO- Osler's node painful red lesions on the pads of the fingers and plantar surfaces PERICARIDUM Janeway lesion/ palmar or plantar erythematous or haemorrhagic papules Bracht-Wachter bodies yellow-white spots in the myocardium CARDIAC TAMPONADE/PERICARDIAL EFFUSION: PERICARDIUM Beck's triad hypotension, increased central venous pressure (JVP), distant heart sounds Ewart's sign percussive dullness, aegophony and bronchial breath sounds at L scapular tip RHEUMATIC FEVER: Anitschkow cell Aschoff body foci of interstitial inflammatiuon in the myocardium and elsewhere EKG OTHER (Osborn wave) positive deflection at QRS-ST junction ANGINA PECTORIS ( Levine's sign) patient clenches fist over chest when asked to describe pain Gallavardin dissociation of musical and noisy elements in ejection murmur phenomenon VASCULAR DISEASE AORTIC ANEURYSM (Cardarelli's sign, left displacement of trachea elicits palpable pulsation of same Oliver's sign) caudal movement of trachea with systole PULMONARY EMBOLISM (McConnell's sign) echocardiography finding of akinesia of the mid-free wall of the right ventricle but normal motion of the apex RADIAL ARTERY SUFFICIENCY (Allen's test) tests for presence of palmar ulnar-radial anastomosis (palmar arch) ARTERIAL PSEUDOHYPERTENSION (Osler's sign) falsely elevated bp reading due to incompressibility of calcified vessels THROMBUS (Lines of Zahn) Adson's sign obliteration of radial pulse with manoeuvres ARTERIOVENOUS FISTULA (Nicoladoni sign) Friedreich's sign collapse of distended neck veins in diastole Caput medusae distended veins radiating from umbilicus Kussmaul's sign increased jugular distension on inspiration Bancroft's sign pain on anterior, but not lateral, compression of calf Homans sign knee bent, ankle abruptly dorsiflexed, popliteal pain Lisker's sign tenderness on percussion of antero-medial tibia DVT Louvel's sign increased pain along vein with valsalva; proximal pressure prevents this VENOUS Lowenberg's sign immediate pain on inflating blood pressure cuff around calf Peabody's sign calf muscle spasm when raising the affected leg with the foot extended Pratt's sign pain elicited by compression of posterior calf Rose's sign Warm, stiff feeling of skin when affected leg is pinched Trendelenburg test SUPERIOR VENA CAVA SYNDROME (Pemberton's sign) arms elevated over head elicits facial plethora, distended neck veins and inspiratory stridor ENDOCRINOLOGY, NUTRITION AND METABOLISM ENDOCRINE DISEASE 1.symptoms associated with hypoglycaemia HYPOGLYCEMIA Whipple’s triad 2. measured low serum glucose 3. relief of symptoms with administration of glucose p.o. or iv EYELID Abadie's sign of exophthalmic levator palpebrae superioris spasm goiter Boston's sign spasmodic ptosis on downward gaze Dalrymple's sign widened palpebral opening GRAVES’ DISEASE/ Stellwag's sign infrequent and/or incomplete blinking, accompanied by Dalrymple's sign GOITRE LID LAG Von Graefe's sign ' lid lag'; immobility of upper lid on downward gaze Griffith's sign lid lag of the lower eyelid on upward eye movement EXTRA OCULAR MUSCLES Möbius sign inability to maintain convergence of eyes HYPOTHYROIDISM Queen Anne’s sign NUTRITION VITAMIN B12 Schilling test affected areas of cervix fail to stain brown with iodine solution DEFICIENCY RICKETS Harrison’s groove rib deformity at the lower thorax CARBOHYDRATE Benedict solution reagent for presence of monosaccharides METABOLIC DISORDERS Chvostek sign tapping over facial nerve elicits abnormal muscle contraction(s) HYPOCALCAEMIA Trousseau sign of latent tetany in hypocalcaemia, occlusion of brachial artery induces carpal spasm PKU Guthrie test others Beutler test EYES AND EARS EYES LACRIMAL: Schirmer's test quantifies lacrimal secretion EYELID: Abadie's sign of ADNEXA levator palpebrae superioris spasm exophthalmic goiter Boston's sign spasmodic ptosis on downward gaze Dalrymple's sign widened palpebral opening Stellwag's sign PUPIL: Argyll Robertson ight-near dissociation pupils Adie pupil dilated pupil, poorly reactive but with normal near accommodation Marcus Gunn pupil IRIS: Fleischer ring Kayser-Fleischer ring ring of brownish copper deposit at corneo-scleral junction Brushfield spots greyish-white spots at periphery of iris Lisch nodule yellow brown hamartomata on iris CONJUNCTIVA: GLOBE Bitot's spots spots of keratin deposition in the conjunctiva Arlt's line RETINA: Hollenhorst plaque cholesterol embolus(i) of retinal artery(ies) Roth's spot retinal haemorrhages with pale centres seen at fundoscopy Fuchs spot OTHERS: Alexander's law describes nystagmus in vestibular lesions Hirschberg test corneal reflection centred (-) or not centred (+) on pupil Siegrist streaks hyperpigmented sreaks parallel to choroidal vessels Hudson–Stahli line EARS AUDITORY: Rinne test comparison of air conduction to bone conduction differentiates sensorineural from conductive
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