Patient Clinical Signs

Question 1

Palmar erythema

Answer 1

Palmar erythema specifically means reddening of the thenar and hypothenar eminences. The equivalent areas on the soles of the feet may also be affected.
Associated wirh

Palmar erythema may be found also in:

Pregnancy
Thyrotoxicosis
Rheumatoid arthritis
Polycythaemia
Chronic febrile disease
Chronic leukaemia
Chronic liver disease
Pregnancy
Hyperthyroidism

Question 2

Tremor

Answer 2

Late sign of carbon dioxide retention
Beta agonist overuse

Question 3

Clubbing

Answer 3

Congenital cyanotic heart disease
Infective endocarditis
Atrial myxoma
Bronchiectasis
Lung cancer
Cystic fibrosis
Inflammatory bowel disease
Lung carcinoma
Empyema
Idiopathic pulmonary fibrosis

Question 4

Hoover’s sign

Answer 4

Patients with COPD have over-inflated lungs. Expansion is reduced. The normal movement of the
costal margins away from the xiphersternum is reversed. The contraction of the diaphragm during
inspiration instead pulls the xiphisternum and costal margins towards one another. When palpating
the expansion of the chest, the effect is to draw the thumbs towards one another when the patient
takes a deep breath

Question 5

Stony dull percussion

Answer 5

pleural effusion

Question 6

Dull percussion

Answer 6

Lung collapse, consolidation

Question 7

Hyper-resonant

Answer 7

Pneumothorax

Question 8

Increased vocal resonance

Answer 8

Consolidation

Question 9

Splinter haemorrhages

Answer 9

small emboli becoming lodged in nailbed capillaries causing secondary haemorrhage.

Causes include:
Local trauma
Infective endocarditis
Sepsis
Vasculitis
Psoriatic nail disease

Question 10

Osler’s nodes

Answer 10

red-purple, slightly raised, tender painful lumps that often have a pale centre. These lesions are typically found on the fingers or toes

Associated with infective endocarditis.

Question 11

Janeway lesions

Answer 11

Non-tender, haemorrhagic lesions that occur on the thenar and hypothenar eminences of the palms and soles.

Associated with infective endocarditis.

Question 12

Asterixis

Answer 12

(also known as ‘flapping tremor’) is a type of negative myoclonus characterised by irregular lapses of posture causing a flapping motion of the hands.

Causes of asterixis include:
CO2 retention (e.g. COPD)
Uraemia
Hepatic encephalopathy

Question 13

Xanthomata

Answer 13

Raised yellow cholesterol-rich deposits that are often noted on the palm, tendons of the wrist and elbow.

Xanthomata are associated with hyperlipidaemia (typically familial hypercholesterolaemia), an important risk factor for cardiovascular disease.

Question 14

Leukonychia

Answer 14

whitening of the nail bed.

Causes include:
Nailbed trauma
Hypoalbuminaemia (e.g. end-stage liver disease, protein-losing enteropathy)
Chemotherapy

Question 15

Koilonychia

Answer 15

spoon-shaped nails.

Causes include:
Iron deficiency anaemia (e.g. Crohn’s disease)
Lichen planus
Rheumatic fever

Question 16

Nail pitting

Answer 16

punctate depressions of the nail plate.

It is most commonly associated with psoriasis.

Question 17

Malar flush

Answer 17

a rose/blue tinge to the cheeks due to dilatation of the malar capillaries.
It is now rare having been associated with pulmonary hypertension and low cardiac output states such as mitral stenosis.