Examination Signs Flashcards
1
Q
Abdominal bruit
A
The sound is higher pitched than a venous hum, is not continuous and is well localised
Over liver = hepatocellular carcinoma; acute alcoholic hepatitis
Over kidneys = renal artery stenosis
Over spleen = tumour
2
Q
Abnormal gait caused by posterior column lesion (description)
A
Clumsy slapping down of the feet on a broad base
3
Q
Clumsy slapping down of the feet on a broad base
A
Abnormal gait caused by posterior column lesion
4
Q
Acanthosis Nigricans
A
GATROINTESTINAL: Rarely GI carcinoma (particularly stomach) and lymphoma; acromegaly; diabetes mellitus; endocrinopathies
ENDOCRINE: acromegaly; insulin resistant states - Cushing’s syndrome, PCOS
5
Q
Addisonian-type pigmentation (‘sunkissed skin’) of nipples, palmar creases, pressure areas, mouth
A
Malabsorption
6
Q
Alkaline urine
A
UTI
7
Q
Angular stomatitis
A
Iron/B12 deficiency
8
Q
Ankle oedema
A
CARDIOVASCULAR: Right ventricular failure, congestive heart failure, DVT
GASTROINTESTINAL: hypoalbuminaemia (cirrhosis)
IATROGENIC/RENAL: fluid overload in nephrotic syndrome
NEOPLASTIC: compression of large veins by tumour
calcium antagonists
9
Q
Antalgic gait (description)
A
Painful gait disorder (most common abnormal gait)
10
Q
Painful gait disorder (most common abnormal gait)
A
Antalgic gait
11
Q
Apex beat = volume loaded (thrusting)
A
Displaced, diffuse, non-sustained
Advanced MR; dilated cardiomyopathy
12
Q
Aphthous (mouth) ulcers
A
IBD
13
Q
Apraxic gait (description + site of lesion)
A
Feet appear glued to the floor when erect but move more easily when the patient is supine
Cortical/prefrontal lobe
14
Q
Feet appear glued to the floor when erect but move more easily when the patient is supine
Cortical/prefrontal lobe
A
Apraxic gait
15
Q
Arcus senilis
A
White, grey, or blue opaque ring in the corneal margin
Hypercholesterolaemia, hyperlipoproteinaemia or hyperlipidaemia
RENAL: hyperlipidaemia in nephrotic syndrome
16
Q
Argyll-robertson pupils (description + condition)
A
Poorly constrict with torchlight but constrict on accommodation
Symptom of syphilis which is associated with heart disease
17
Q
Poorly constrict with torchlight but constrict on accommodation
Symptom of syphilis which is associated with heart disease
A
Argyll-robertson pupils
18
Q
Ataxic gait (description + site of lesion)
A
Unbalanced/drunken gait which is wide based or reeling on a narrow base.
The patient staggers towards the affected side if there is a unilateral cerebellar hemisphere lesion.
Cerebellar
19
Q
Unbalanced/drunken gait which is wide based or reeling on a narrow base.
The patient staggers towards the affected side if there is a unilateral cerebellar hemisphere lesion.
Cerebellar
A
Ataxic gait
20
Q
Beau’s lines
A
Non-pigmented indented transverse bands
Any cause of catabolic state
21
Q
Bilateral palpable kidneys
A
Polycystic kidneys Hydronephrosis Pyonephrosis Diabetic nephropathy (early) Nephrotic syndrome Acromegaly Renal cell carcinoma bilaterally
22
Q
Black urine
A
Serve haemoglobinuria
Metronidazole
Melanoma
23
Q
Bounding/collapsing carotid pulse
A
Aortic regurgitation; patent ductus arteriosus
24
Q
Breath odour
A
Fetor hepaticus (sweet smell); Faeculent in obstruction Ketotic breath (fruity) in ketoacidosis Alcohol breath (drunk recently or alcoholic) Uraemic fetor (uraemia, in CKD)
25
Brown urine
Bilirubin
Phenothiazides
Senna
Rhubarb
26
Bruising
RENAL: Nitrogen retention
27
Buerger’s test
With the patient supine, elevate both legs to an angle of 45 degrees and hold for one to two minutes. Observe the color of the feet. Pallor indicates ischaemia. It occurs when the peripheral arterial pressure is inadequate to overcome the effects of gravity. The poorer the arterial supply, the less the angle to which the legs have to be raised for them to become pale.
Used to assess the adequacy of the arterial supply to the leg.
28
Butterfly rash
Systemic Lupus Erythematosus (SLE)
29
Cachectic appearance
Severe loss of weight and muscle wasting
Malignant disease; anorexia; impaired absorption
CARDIOVASCULAR: severe cardiac failure
RESPIRATORY: emphysema, cancer
30
Caput medusa
Prominent veins with the direction of flow going away from the umbilicus - (check by pressing on vein with two fingers and lifting one to see if that side refills)
Portal hypertension
31
Casts in urine
Cylindrical moulds formed in the lumen of the renal tubules or collecting ducts
Signs of a damaged glomerular basement membrane or damaged tubules
32
Clubbing
GASTROINTESTINAL: cirrhosis, IBD, coeliac, AV shunting in lungs
CARDIOVASCULAR: Cyanotic congenital heart disease, infective endocarditis
RESPIRATORY: Idiopathic pulmonary fibrosis; lung cancer, CF, bronchiecstasis, sarcoidosis, TB; hypertrophic pulmonary osteoarthropathy (HPO)
ENDOCRINE: Rarely in Grave’s disease, but not seen in other causes of thyrotoxicosis
33
Collapsing (bounding) pulse
Aortic regurgitation; patent ductus arteriosus; AV malformations
34
Complete absence of bowel sounds for 4 mins
Paralytic ileus (complete absence of peristalsis in the bowel)
35
Conjunctival pallor
Anaemia (bleeding, malabsorption, EPO deficiency)
36
Corrigan’s sign/pulse
A jerky carotid pulse characterized by full
expansion followed by quick collapse
Aortic regurgitation
37
De Musset’s sign
Rhythmic nodding or bobbing of the head in synchrony with the beating of the heart
Aortic regurgitation
38
Displacement of apex beat
Heart enlargement, Marfan's, chest wall deformity, pleural/pulmonary disease
39
Distension of the stomach
Begin with ‘F’
- Fat
- Fluid (ascites)
- Foetus
- Flatus (gas due to bowel obstruction)
- Faeces
- ‘Filthy’ big tumour
- ‘Phantom’ pregnancy
40
Dull percussion note in the flanks
Ascites (when at least 2L of fluid have accumulated)
- Cirrhosis
- Alcoholic hepatitis
- Congestive heart failure
- TB
- Nephrotic syndrome
41
Dupuytren’s contracture
Familial, alcoholism
42
Dyspnoea (renal)
Fluid overload
43
Extensor tendon xanthomata
Hyperlipidaemia (type II) (elevated serum cholesterol)
44
Fat hypertrophy on stomach
Insulin scars (may be)
45
Fatty casts in urine
Nephrotic syndrome
46
Fetor hepaticus
Sweet smell; faeculent in obstruction
47
Fine crackles in lungs
Fibrosing alveolitis, pulmonary oedema
48
Firm, irregular liver
Hepatocellular carcinoma, metastatic disease, cirrhosis
49
Fishy smell in urine
UTI
50
Foot slapping (description + site of lesion)
Bilateral foot drop
Anterior tibial muscles not working properly
51
Bilateral foot drop
Anterior tibial muscles not working properly
Foot slapping
52
Freckle-like spots around the mouth, fingers, and toes
Puetz-Jeghers syndrome (autosomal dominant condition) - harmatomas of small bowel or colon
53
Friction rub
A rough creaking or grating noise is heard as the patient breathes
Over liver = tumour, liver abscess, liver infarct, recent liver biopsy
Over spleen = splenic infarct
54
Frozen pelvis from cervical cancer
Urinary tract obstruction
| Secondary renal failure
55
Function of hepatojugular reflex
Pressing on liver causes surge of blood = increases likelihood of seeing JVP
56
Gallbladder enlargement with jaundice
Carcinoma of head of pancreas or ampulla of Vater, in situ gallstones
57
Gallbladder enlargement without jaundice
Carcinoma of gallbladder, acute cholecystitis
58
Generalised hyperpigmentation of skin
Chronic liver disease
| Haemochromatosis
59
Gingivial hypertrophy
RENAL: Immunosuppressive drugs (transplant patients)
60
Glossitis
Iron/B12 deficiency; common in alcoholics
61
Glucosuria
Diabetes mellitus, impaired renal ability to absorb glucose
False-positives may be from
- Metabolites of salicylates, ascorbic acid, galactose, fructose
62
Guarding of the abdomen
```
Voluntary = tenderness or anxiety
Involuntary = peritonitis
```
63
Gum hypertrophy
```
Phenytoin use
Pregnancy
Scurvy (vit C deficiency)
Gingivitis (may be smoking)
Leukaemia
```
64
Gynaecomastia
GASTROINTESTINAL: Increased levels of oestrogen in liver disease
- Cirrhosis (particularly alcoholism)
- Chronic autoimmune hepatitis
65
Haematuria
RENAL: Glomerulonephritis, polycystic kidney disease, pyelonephritis, renal cell carcinoma, analgesic nephropathy, malignant hypertension, renal infarction
Renal tract = cystitis, calculi, bladder/ureteric tumour
66
Haemorrhages of the eyes
Infective endocarditis
67
Heart sounds (renal)
CV/RENAL: Uraemic pericarditis
68
Heaves
Left ventricular hypertrophy
69
Hemiparetic gait (description)
Foot is plantarflexed (unable to dorsiflex) and leg is swung in a lateral arc (circumducted) to compensate for inability to dorsiflex foot properly
One leg looks stiff
70
Foot is plantarflexed (unable to dorsiflex) and leg is swung in a lateral arc (circumducted) to compensate for inability to dorsiflex foot properly
One leg looks stiff
Hemiparetic gait
71
Hepatic flap (asterixis)
Hepatic encephalopathy
Uraemia
Terminal chronic renal failure
72
Hepatojugular reflex
Pressure exerted over the middle of the abdomen for 10 seconds will increase venous return to the right atrium. The JVP normally rises transiently following this manoeuvre
Is positive if JVP remains elevated for duration of compression
Left ventricular failure; reduced right ventricular compliance
73
Hepatomegaly
Enlarged liver (normal span
74
Hepatosplenomegaly
Chronic liver disease with portal hypertension; haematological disease; infection; acromegaly; thyrotoxicosis; infiltration (eg infective mononucleosis, viral hepatitis)
75
Hicupping
Can be a sign of advanced uraemia
76
High arched palate
Marfan's syndrome
77
High stepping (description + cause)
Tend to overcompensate when walking
Secondary neurosyphilis
78
Tend to overcompensate when walking
Secondary neurosyphilis
High stepping
79
Homans’ sign
Pain in the calf of the leg upon dorsiflexion of the foot with the leg extended.
DVT
80
Hyperventilation
Metabolic acidosis
81
Increased muscle bulk
Steroid use (which can also cause liver tumours and hepatic carcinomas)
82
Irregularly irregular pulse rhythm
Atrial fibrillation (AV nodal blocking drugs, alcohol, post-thoracotomy); mitral valve disease; ventricular ectopics
83
Janeway lesions
Flat, non-painful lesions on palm
Infective endocarditis
84
Jaundice
GASTROINTESTINAL: Liver disease, cancer (head of the pancreas, Ampulla of Vater, gallbladder), in situ gallstones
CARDIOVASCULAR: Severe congestive heart failure, hepatic congestion
RENAL: Retention of nitrogenous wastes (can cause haemolysis)
85
Kayser-Fleischer rings
Brownish-green rings in periphery of cornea - deposits of excessive copper
Wilson’s disease - copper storage disease that causes cirrhosis and neurological disturbances; may also be other cholestatic liver disease
86
Keith-Wegerer hypertensive changes
Some reported symptoms include blurred vision, headache, and a sensation of pressure in the eyes
Diabetic changes
87
Ketonuria
Diabetic ketoacidosis, starvation
88
Ketotic breath
Fruity; in ketoacidosis
89
Koilonychia
Iron deficiency anaemia
| RENAL: in nephritic syndrome
90
Kussmaul’s sign
Rise in JVP on inspiration
Right heart failure, causing limited right ventricular filling
91
Large blood pulse pressure
Aortic regurgitation
92
Left iliac fossa mass
Faeces
Carcinoma of sigmoid or descending colon
Diverticular abscess
Ovarian tumour/cyst
93
Leg ulcers (types + causes)
VIMIN
Venous stasis ulcer (most common)
Ischaemic ulcer (over pressure areas)
Malignant ulcer
Infection (e.g. Staph. aureus)
Neuropathic
Underlying systemic disease (e.g. diabetes, RA, lymphoma)
94
Leucoplakia
Begin with ‘S’
- Sore teeth (poor dental hygiene)
- Smoking
- Spirits
- Sepsis
- Syphilis
95
Leukonychia
Hypoalbuminaemia in liver disease, nephrotic syndrome
96
Loud, high-pitched bowel sound with tinkling
Bowel obstruction
97
Lung sounds (renal)
Pulmonary oedema in nephrotic syndrome
98
Malar flush
Mitral stenosis
99
Marfan's Syndrome
Long arms, legs and fingers; Tall and thin body type; Curved spine; Chest sinks in or sticks out; Flexible joints; Flat feet; Crowded teeth
- Can cause distortion of the heart and great vessels in the chest
- Alter position of apex beat, can also interfere with pulmonary function
100
Mechanical gait cause
Hip arthritis
101
Mitral facies
Rosy cheeks with a bluish tinge due to dilatation of the malar capillaries
Pulmonary hypertension (low cardiac output that occurs in severe mitral stenosis)
102
Murphy's sign
Positive in acute cholecystitis
103
Murphy’s kidney punch
Gentle use of the clenched fist to strike the patient in the renal angle
Elicits renal tenderness in renal infection
104
Muscle wasting
Malabsorption; malnutrition; alcoholism
105
Myoglobulinaemia
Due to destruction of muscle
Muscle infarction (trauma), excess muscle contraction, viral myositis, drugs or toxins (alcohol, snake venom, statins)
106
Narrow blood pulse pressure
Aortic stenosis
107
Nitrites in urine
UTI - but poor sensitivity
108
Normal capillary refill time
>2sec
109
Osler's nodes
Painful nodes on tips of fingers
Infective endocarditis
110
Pale urine
Dilute urine
- Overhydration
- Recent excessive beer consumption
- Diabetes inspipidus
111
Pallor in palmar creases
Anaemia associated with renal failure
- Due to poor nutrition (esp. folate), blood loss, EPO deficiency, haemolysis, bone marrow depression,
112
Pallor of the face
Anaemia
113
Palmar erythema
Hyperdynamic circulation due to increased oestrogen levels in liver disease/pregnancy; thyrotoxicosis; RA
114
Palmar xanthomata
Hyperlipidaemia (type III) (elevated serum cholesterol)
115
Palpable bump over right or left pectoral muscle
Pacemaker
116
Parkinsonian gait (description + site of lesion)
Hesitation in starting (shuffling, freezing, festination, propulsion, retropulsion)
Resting tremor in affected hand (unilateral)
Extrapyrimidal
117
Hesitation in starting (shuffling, freezing, festination, propulsion, retropulsion)
Resting tremor in affected hand (unilateral)
Extrapyrimidal
Parkinsonian gait
118
Percussion heart outline - distance >10.5cm between border of heart and middle sternum
Cardiomegaly
119
Periorbital oedema
Renal: nephritic syndrome
120
Periorbital xanthelasma
Hyperlipidaemia (elevated serum cholesterol) in cholestasis; common in people with primary biliary cirrhosis
121
Peripheral cyanosis
Poor peripheral circulation, low oxygen delivery
122
Persistent proteinuria
Renal disease
No renal disease
- Exercise, fever, congestive cardiac failure, blood transfusion, severe hypertension
123
Petechiae
Pin-head sized bruises - non-blanching
Chronic alcoholism (causing bone marrow depression)
124
Petechiae on inner lip
Infective endocarditis
125
Petechial haemorrhages
Infective endocarditis
126
Pink urine
Beetroot consumption
Phenindione (anticoagulant, rarely used)
Laxatives
127
Poor capillary refill
Septic shock, poor peripheral circulation
128
Poor dental hygiene
Source of organisms responsible for Infective endocarditis
129
Postural drop in blood pressure
>20mmHg = postural hypotension
Common causes = use of anti-hypertensive drugs (alpha-adrenergic antagonists in particular), Addison’s disease; neuropathy; hypovolaemia
130
Prostatomegaly (renal)
Urinary tract obstruction
| Secondary renal failure
131
Proteinuria
Protein in the urine (>3.4g per 24 hours)
```
Primary pathology
- Glomerulonephritis
- Glomerulosclerosis
Secondary pathology
- Drugs, diabetes, lupus, malignancy, infections (hep A, hep C, HIV, malaria, infective endocarditis)
```
132
Psychogenic/hysterical gait description
Characterised by a bizarre, inconsistent gait
| Rarely tend to fall over despite having a gait disorder
133
Characterised by a bizarre, inconsistent gait
| Rarely tend to fall over despite having a gait disorder
Psychogenic/hysterical gait
134
Pulsus alternans
Alternating strong and weak pulse
Advanced left ventricular failure
135
Pyuria
UTI
136
Quincke’s sign
Alternate blanching and flushing of the nail bed due to pulsation of subpapillary arteriolar and venous plexuses
Aortic regurgitation
137
Radial-radial delay
Large arterial occlusions (atherosclerotic plaque, aneurysm, subclavian artery stenosis on one side); dissection of thoracic aorta
138
Radio-femoral delay
Coarctation of the aorta (congenital narrowing of the aortic isthmus); Aortic arch aneurysm
139
Raised JVP
“PQRST”
- Pulmonary (SHE: stenosis, hypertension, embolism), pericarditis, pericardial effusion, cor pulmonale
- Quantity of fluid i.e. overload (in nephrotic syndrome)
- Right heart failure
- SVC obstruction
- Tamponade, tricuspid regurgitation
140
RBCs in urine - high number, irregular size and shape
Originate from glomeruli
141
RBCs in urine - high number, uniform shape
Originate from renal tract
142
Rebound tenderness
Strongly suggests peritonitis
143
Red cell casts in urine
Contain 10 to 50 red cells, which are well defined
Primary glomerular disease (haematuria of glomerular origin or vasculitis)
144
Red urine
Haematuria, haemoglobinuria, myoglobinuria
Porphyrins
Rifampicin
Beetroot consumption
145
Regularly irregular pulse rhythm
Sinus arrhythmia; 2nd degree AV block
146
Renal bruits - diastolic
Bruits heard above umbilicus, about 2cm right or left of midline
More likely to be haemodynamically significant
Renal artery stenosis from fibromuscular dysplasia or atherosclerosis
147
Renal bruits - soft systolic
Bruits heard above umbilicus, about 2cm right or left of midline
May be renal artery stenosis, but less likely
Aorta or splenic artery may be source of sound
148
Renal tenderness or loin tenderness
Renal colic
149
Right iliac fossa mass
```
Abscess of appendix
Carcinoma of caecum or caecum obstruction
Crohn’s disease
Ovarian tumor/cyst
Hernia
Transplanted kidney
```
150
Rigidity
Peritoneal irritation
151
Rosving’s sign
Appendicitis
152
Ruddy plethoric complexion
Polycythaemia
153
S1 heart sound (represents + site louder)
Onset of ventricular contraction and the closure of the AV valves.
Louder at the tricuspid and mitral areas
154
Scar on right or left iliac fossa, quite posterior
Nephrectomy scar
155
Scratch marks
GASTROINTESTINAL: Due to severe itch (pruritis) caused by obstructive/cholestatic jaundice
RENAL: Uraemic puritis - often associated with hyperphosphataemia
156
Single transverse white band on the nails
Arsenic poisoning; renal failure
157
Skin turgor
A decrease in skin turgor is indicated when the skin (on the back of the hand for an adult or on the abdomen for a child) is pulled up for a few seconds and does not return to its original state.
Decrease = late sign of dehydration
158
Slow rising low volume of carotid pulses
Aortic stenosis
159
Spastic paraparesis (description + site of lesion)
Scissor gait, both legs stiff
Pyrimidal
160
Scissor gait, both legs stiff
Pyrimidal
Spastic paraparesis
161
Spider naevi
>5 is notable
| Cirrhosis, transiently in viral hepatitis, 2-5mths of pregnancy. Often attributed to excess oestrogen.
162
Splinter haemorrhages
Infective endocarditis; trauma; RA
163
Striae
Pink linear marks with wrinkles appearance
Usually pregnancy or recent weight gain
When wide and purple = Cushing’s syndrome
164
Supraclavicular lymphadenopathy (especially Virchow’s node - in left supraclavicular fossa)
Abdominal malignancy
165
Swollen cyanotic face
SVC obstruction
166
Systemic sclerosis
Tense tethering of skin
| GATROINTESTINAL: Gastro-oesophageal reflux; Gastrointestinal motility disorders
167
Tachycardia & low blood volume
Blood loss
168
Tender liver
Hepatitis, abscess, biliary obstruction, rapid liver enlargement (right heart failure)
169
Tendon xanthomata
Cholesterol deposits = risk factor for CVD
170
Testicular atrophy
Chronic liver disease
| Haemochromatosis
171
Thrills
Palpable murmurs
Usually organic lesions
172
Thrills over carotid artery
Aortic stenosis, atheroma
173
Twitching, tetany, epileptic seizures
Low calcium levels - late in renal failure
174
Unilateral palpable kidney
```
Renal cell carcinoma
Hydronephrosis pyonephrosis
Polycystic kidney disease
Acute renal thrombosis
Acute pylonephritis
Renal abscess
```
175
Upper abdominal mass
Carcinoma of stomach
AAA
Gastric dilatation (pyloris stenosis, diabetic ketoacidosis)
Small bowel obstruction
176
Uraemic fetor
Uraemia; in CKD
177
Uraremic tinge
Dirty brown complexion
Chronic renal failure - impaired excretion of urinary pigments combined with anaemia
178
Venous hum
A continuous, low-pitched, soft murmur that may become louder with inspiration and diminish when more pressure is applied to the stethoscope
Between the xiphisternum and the umbilicus = portal hypertension
Over umbilicus = almost always cirrhosis of liver
179
Visible peristalsis
Intestinal obstruction
180
Waddling gait (cause)
Proximal muscle weakness
181
White cell cast in urine
Many WBCs adhere to or inside the cast
Bacterial pyelonephritis
Glomerulonephritis (less common)
Kidney infarction
Vasculitis
182
White/milky urine
Chyluria
183
Xanthelasma
Hyperlipidaemia (e.g. in nephrotic syndrome), atherosclerosis
Endocrine: diabetes, hypothyroidism
184
Yellow tinge to face
Uraemia
185
Yellow-orange urine
Concentrated urine
- Dehydration
- Bilirubin
- Tetracycline, rifampicin, riboflavin
