Mechanisms of Clinical Signs, 2e PDF

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Dennis, Bowen and Cho 2nd Edition Mechanisms of CliniCal SignS Study smart with Mechanisms of CLINICAL SIGNS 2nd Edition Mark Dennis MBBS (Honours) Cardiology Advance Trainee /Intensive Care Trainee, Royal Prince Alfred Hospital, Clinical Lecturer, Sydney Medical School, University of Sydney, NSW, Australia William Talbot Bowen MBBS, MD Emergency Medicine Physician, Board Eligible Louisiana State University Health Sciences Center New Orleans, LA, United States Lucy Cho BA, MBBS, MIPH General Practice Registrar Appletree Family Practice Newcastle, NSW, Australia In Memoriam Doctor John Morgan 27.9.1930–14.7.2014 Surgeon, gentleman, teacher and friend. ‘I shall not see his like again’ Elsevier Australia, ACN 001 002 357 (a division of Reed International Books Australia Pty Ltd) Tower 1, 475 Victoria Avenue, Chatswood, NSW 2067 Copyright 2016 Elsevier Australia. 1st edition © 2012 Elsevier Australia All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Details on how to seek permission, further information about the Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/ permissions. This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein). Notice This publication has been carefully reviewed and checked to ensure that the content is as accurate and current as possible at time of publication. We would recommend, however, that the reader verify any procedures, treatments, drug dosages or legal content described in this book. Neither the author, the contributors, nor the publisher assume any liability for injury and/or damage to persons or property arising from any error in or omission from this publication. National Library of Australia Cataloguing-in-Publication Data Dennis, Mark, 1978- author. Mechanisms of clinical signs / Mark Dennis, William Talbot Bowen, Lucy Cho. Second edition. 9780729542371 (paperback) Symptoms–Handbooks, manuals, etc. Diagnosis–Handbooks, manuals, etc. Bowen, William Talbot, author. Cho, Lucy, author. 616.075 Content Strategist: Larissa Norrie Senior Content Development Specialist: Neli Bryant and Lauren Santos Senior Project Manager: Karthikeyan Murthy Edited by Katie Millar Proofread by Annabel Adair Illustrations by Toppan Best-set Premedia Limited and Alan Laver Design by Tania Gomes Index by Robert Swanson Typeset by Toppan Best-set Premedia Limited Printed by CTPS, China v Contents Contents by condition ix Foreword xv Preface xvi Acknowledgements xvi Reviewers xvii Abbreviations xix Sign value xxii Chapter 1 Musculoskeletal Signs 1 Anterior drawer test 2 Apley’s grind test 3 Apley’s scratch test 4 Apparent leg length inequality (functional leg length) 5 Apprehension test 7 Apprehension–relocation test (Fowler’s sign) 8 Bouchard’s and Heberden’s nodes 9 Boutonnière deformity 10 Bulge/wipe/stroke test 12 Butterfly rash (malar rash) 13 Calcinosis/calcinosis cutis 15 Charcot foot 17 Crepitus 19 Dropped arm test 20 Finkelstein’s test 21 Gottron’s papules 22 Hawkins’ impingement test 23 Heliotrope rash 25 Kyphosis 26 Lachman’s test 28 Livedo reticularis 29 McMurray’s test 32 Neer’s impingement test 33 Patellar apprehension test 35 Patellar tap 36 Patrick’s test (FABER test) 37 Phalen’s sign 38 Proximal weakness/proximal myopathy 39 Psoriatic nails/psoriatic nail dystrophy 40 Raynaud’s syndrome/phenomenon 42 Saddle nose deformity 45 Sausage-shaped digits (dactylitis) 46 Sclerodactyly 48 Shawl sign 49 Simmonds–Thompson test 50 Speed’s test 51 Subcutaneous nodules (rheumatoid nodules) 52 Sulcus sign 53 Supraspinatus test (empty-can test) 54 Swan-neck deformity 55 Telangiectasia 57 Thomas’ test 59 Tinel’s sign 60 Trendelenburg’s sign 61 True leg length inequality (anatomic leg length inequality) 62 Ulnar deviation 63 V-sign 64 Valgus deformity 65 Varus deformity 68 Yergason’s sign 70 Chapter 2 Respiratory Signs 77 Accessory muscle breathing 78 Agonal respiration 80 Apneustic breathing (also apneusis) 81 Apnoea 82 Asterixis 85 Asymmetrical chest expansion 86 Asynchronous respiration 89 Ataxic (Biot’s) breathing 90 Barrel chest 92 Bradypnoea 94 Breath sounds 95 Breath sounds: bronchial 98 Breath sounds: reduced or diminished 99 Cough reflex 104 Crackles (rales) 107 Dahl’s sign and tripod position 110 Dyspnoea 111 Funnel chest (pectus excavatum) 116 Grunting 117 Haemoptysis 118 Harrison’s sulcus (also Harrison’s groove) 119 Hoover’s sign 121 Hypertrophic pulmonary osteoarthropathy (HPOA) 122 Hyperventilation 124 Intercostal recession 126 Kussmaul’s breathing 127 Orthopnoea 129 Paradoxical abdominal movements (also abdominal paradox) 132 Paradoxical respiration/breathing 133 Paroxysmal nocturnal dyspnoea (PND) 134 Percussion 135 Percussion: dullness 136 Percussion: resonance/hyper-resonance 137 Periodic breathing 138 Pigeon chest (pectus carinatum) 139 Platypnoea/orthodeoxia 140 Pleural friction rub 143 Pursed-lip breathing (PLB) 144 Sputum 145 Stertor 146 Stridor 147 Subcutaneous emphysema/surgical emphysema 149 Tachypnoea 151 Dennis_2371_Table of Contents_main.indd 5 8/3/2015 6:49:36 PM �� Simpo PDF Password Remover Unregistered Version - http://www.simpopdf.com Contents vi Tracheal tug 153 Trepopnoea 154 Vocal fremitus/tactile fremitus 155 Vocal resonance 156 Wheeze 157 Chapter 3 Cardiovascular Signs 165 Apex beat (also cardiac impulse) 166 Apex beat: displaced 167 Apex beat: double or triple impulse 168 Apex beat: hyperdynamic apical impulse/volume-loaded 169 Apex beat: left ventricular heave/sustained apical impulse/pressure-loaded apex 170 Apex beat: tapping 171 Arterial pulse 172 Arterial pulse: anacrotic pulse 175 Arterial pulse: bigeminal 176 Arterial pulse: dicrotic 177 Arterial pulse: pulsus alternans 178 Arterial pulse: pulsus bisferiens 180 Arterial pulse: pulsus parvus et tardus 182 Arterial pulse: sinus arrhythmia 184 Bradycardia 185 Buerger’s sign 187 Capillary return decreased/delayed 188 Cardiac cachexia 190 Carotid bruit 192 Cheyne–Stokes breathing 193 Clubbing 196 Crackles (also rales) 198 Cyanosis 199 Cyanosis: central 200 Cyanosis: peripheral 202 Ewart’s sign 203 Hepatojugular reflux (also abdominojugular reflux) 204 Hypertensive retinopathy 206 Hypertensive retinopathy: arteriovenous (AV) nipping (or AV nicking) 207 Hypertensive retinopathy: copper and silver wiring 208 Hypertensive retinopathy: cotton wool spots 209 Hypertensive retinopathy: microaneurysms 210 Hypertensive retinopathy: retinal haemorrhage 211 Hypertrophic obstructive cardiomyopathy murmur 212 Janeway lesions 214 Jugular venous pressure (JVP) 215 JVP: Kussmaul’s sign 217 JVP: raised 219 JVP: the normal waveform 221 JVP waveform variations: a-waves – cannon 222 JVP waveform variations: a-waves – prominent or giant 224 JVP waveform variations: v-waves – large 226 JVP waveform variations: x-descent – absent 227 JVP waveform variations: x-descent – prominent 228 JVP waveform variations: y-descent – absent 229 JVP waveform variations: y-descent – prominent (Friedrich’s sign) 231 Mid-systolic click 233 Mitral facies 235 Mottling 236 Murmurs 237 Murmurs – systolic: aortic stenotic murmur 238 Murmurs – systolic: mitral regurgitation murmur 241 Murmurs – systolic: pulmonary stenotic murmur 243 Murmurs – systolic: tricuspid regurgitation murmur (also Carvello’s sign) 244 Murmurs – systolic: ventricular septal defect murmur 246 Murmurs – diastolic: aortic regurgitation 248 Murmurs – diastolic: eponymous signs of aortic regurgitation 250 Murmurs – diastolic: Graham Steell murmur 252 Murmurs – diastolic: mitral stenotic murmur 253 Murmurs – diastolic: opening snap (OS) 254 Murmurs – diastolic: pulmonary regurgitation murmur 255 Murmurs – diastolic: tricuspid stenotic murmur 256 Murmurs – continuous: patent ductus arteriosus murmur 257 Osler’s nodes 259 Passive leg raise with blood pressure or pulse pressure change 260 Pericardial knock 261 Pericardial rub 262 Peripheral oedema 263 Pulse pressure 267 Pulse pressure: narrow 268 Pulse pressure variation 270 Pulse pressure: widened 274 Pulsus paradoxus 277 Radial–radial delay 281 Radio-femoral delay 282 Right ventricular heave 283 Roth spots 284 Dennis_2371_Table of Contents_main.indd 6 8/3/2015 6:49:36 PM �� Simpo PDF Password Remover Unregistered Version - http://www.simpopdf.com Contents vii S1 (first heart sound): normal 286 S1 (first heart sound): accentuated 287 S1 (first heart sound): diminished 288 S2: loud (or loud P2 – pulmonary component of second heart sounds) 289 S3 (third heart sound) 290 S4 (fourth heart sound) 291 Skin turgor: decreased 292 Splinter haemorrhages 293 Splitting of the heart sounds 294 Splitting heart sounds: physiological splitting 295 Splitting heart sounds: paradoxical (reverse) splitting 297 Splitting heart sounds: widened splitting 299 Splitting heart sounds: widened splitting – fixed 300 Tachycardia (sinus) 301 Xanthelasmata 303 Chapter 4 Haematological and Oncological Signs 313 Angular stomatitis 314 Atrophic glossitis 315 Bone tenderness/bone pain 316 Chipmunk facies 319 Conjunctival pallor 321 Ecchymoses, purpura and petechiae 322 Gum hypertrophy (gingival hyperplasia) 325 Haemolytic/pre-hepatic jaundice 326 Koilonychia 329 Leser–Trélat sign 330 Leucoplakia 331 Lymphadenopathy 332 Neoplastic fever 337 Peau d’orange 338 Prostate (abnormal) 340 Rectal mass 341 Trousseau’s sign of malignancy 342 Chapter 5 Neurological Signs 347 Guide to the ‘Relevant neuroanatomy and topographical anatomy’ boxes 349 Abducens nerve (CNVI) palsy 351 Anisocoria 355 Anosmia 360 Argyll Robertson pupils and light–near dissociation 363 Ataxic gait 366 Atrophy (muscle wasting) 369 Babinski response 373 Bradykinesia 375 Broca’s aphasia (expressive aphasia) 378 Brown-Séquard syndrome 381 Brudzinski sign 384 Cavernous sinus syndrome 385 Clasp-knife phenomenon 388 Clonus 389 Cogwheel rigidity 391 Corneal reflex 393 Crossed-adductor reflex 396 Dysarthria 397 Dysdiadochokinesis 399 Dysmetria 401 Dysphonia 403 Essential tremor 405 Facial muscle weakness (unilateral) 407 Fasciculations 412 Gag reflex 414 Gerstmann’s syndrome 417 Glabellar tap (Myerson’s sign) 419 Global aphasia 420 Grasp reflex 422 Hand dominance 423 Hearing impairment 424 Hemineglect syndrome 427 High stepping gait 429 Hoarseness 432 Hoffman’s sign 435 Horner’s syndrome 437 Hutchinson’s pupil 441 Hutchinson’s sign 443 Hyperreflexia 444 Hyporeflexia and areflexia 447 Hypotonia 452 Intention tremor 454 Internuclear ophthalmoplegia (INO) 456 Jaw jerk reflex 458 Jolt accentuation 460 Kernig’s sign 461 Light–near dissociation 462 Myotonia – percussion, grip 465 Oculomotor nerve (CNIII) palsy 467 Optic atrophy 474 Orbital apex syndrome 476 Palmomental reflex 479 Papilloedema 480 Parkinsonian gait 482 Parkinsonian tremor 483 Photophobia 484 Physiological tremor 486 Pinpoint pupils 487 Pronator drift 492 Ptosis 495 Relative afferent pupillary defect (RAPD) (Marcus Gunn pupil) 498 Rigidity 501 Romberg’s test 503 Sensory level 505 Sensory loss 507 Spasticity 516 Sternocleidomastoid and trapezius muscle weakness (accessory nerve [CNXI] palsy) 518 Dennis_2371_Table of Contents_main.indd 7 8/3/2015 6:49:36 PM �� Simpo PDF Password Remover Unregistered Version - http://www.simpopdf.com Contents viii Tongue deviation (hypoglossal nerve [CNXII] palsy) 520 Trochlear nerve (CNIV) palsy 522 Truncal ataxia 526 Uvular deviation 528 Vertical gaze palsy 530 Visual acuity 532 Visual field defects 535 Waddling gait (bilateral Trendelenburg gait) 541 Wallenberg’s syndrome (lateral medullary syndrome) 543 Weakness 545 Wernicke’s aphasia (receptive aphasia) 558 Chapter 6 Gastroenterological Signs 571 Ascites 572 Asterixis (also hepatic flap) 581 Bowel sounds 582 Bowel sounds: absent 583 Bowel sounds: hyperactive (borborygmus) 585 Bowel sounds: tinkling 586 Caput medusae 587 Cheilitis granulomatosa 589 Coffee ground vomiting/bloody vomitus/haematemesis 590 Courvoisier’s sign 592 Cullen’s sign 594 Erythema nodosum 596 Grey Turner’s sign 598 Guarding 599 Gynaecomastia 600 Haematuria 603 Hepatic encephalopathy 605 Hepatic foetor 608 Hepatic venous hum 609 Hepatomegaly 610 Jaundice 612 Kayser–Fleischer rings 616 Leuconychia 618 McBurney’s point tenderness (Surgical sign) 620 Melaena 621 Mouth ulcers (aphthous ulcer) 622 Muehrcke’s lines 623 Murphy’s sign (Surgical sign) 624 Obturator sign (Surgical sign) 625 Oliguria/anuria 627 Palmar erythema 629 Pruritic scratch marks/pruritus 632 Psoas sign (Surgical sign) 636 Pyoderma gangrenosum 637 Rebound tenderness (Surgical sign) 638 Rigidity and involuntary guarding (Surgical sign) 639 Rovsing’s sign (Surgical sign) 640 Scleral icterus 641 Sialadenosis 642 Sister Mary Joseph nodule (Surgical sign) 643 Spider naevus 644 Splenomegaly 646 Steatorrhoea 649 Striae 651 Uveitis/iritis 652 Chapter 7 Endocrinological Signs 661 Acanthosis nigricans (AN) 662 Angioid streaks 665 Atrophic testicles 666 Ballotable kidney 668 Bruising 669 Chvostek’s sign 671 Cushingoid habitus 673 Diabetic amyotrophy (lumbar plexopathy) 675 Diabetic retinopathy 676 Frontal bossing 680 Galactorrhoea 681 Goitre 684 Granuloma annulare 686 Graves’ ophthalmopathy (orbitopathy) 687 Hirsutism 692 Hypercarotinaemia/carotenoderma 694 Hyperpigmentation and bronzing 696 Hyperreflexia 699 Hyperthyroid tremor 700 Hyporeflexia/delayed ankle jerks (Woltman’s sign) 701 Hypotension 703 Macroglossia 706 Necrobiosis lipoidica diabeticorum (NLD) 708 Onycholysis (Plummer’s nail) 709 Pemberton’s sign 710 Periodic paralysis 712 Plethora 713 Polydipsia 715 Polyuria 716 Polyuria: Cushing’s syndrome 719 Pre-tibial myxoedema (thyroid dermopathy) 720 Prognathism 722 Proximal myopathy 723 Skin tags (acrochordon) 726 Steroid acne 727 Trousseau’s sign 728 Uraemic frost 729 Vitiligo 730 Webbed neck (pterygium colli deformity) 732 Figure credits 739 Index 746 Dennis_2371_Table of Contents_main.indd 8 8/3/2015 6:49:36 PM �� Simpo PDF Password Remover Unregistered Version - http://www.simpopdf.com ix Acidotic states: diabetic ketoacidosis Kussmaul’s respiration 127 Acromegaly Frontal bossing 680 Acanthosis nigricans 662 Prognathism 722 Skin tags 726 Addison’s disease Hyperpigmentation 696 Hypotension 703 Vitiligo 730 Airway obstruction Stertor 146 Stridor 147 Anaemia and nutrient deficiency Dyspnoea 111 Hyperventilation 124 Intercostal recession 126 Angular stomatitis 314 Atrophic glossitis 315 Koilonychia 329 Conjunctival pallor 321 Jaundice 612 Cyanosis 199 Tachycardia 301 Hyperdynamic/volume-loaded beat 169 Carotid bruit 192 Widened pulse pressure 274 Diminished S1 288 Ankle/foot signs Charcot foot 17 Simmonds –Thompson test 50 Valgus deformity 65 Varus deformity 68 Aortic regurgitation Hyperdynamic/volume-loaded beat 169 Pulsus bisferiens 180 Diastolic murmur 250 Austin Flint murmur 250 Becker’s sign 250 Corrigan’s sign 250 De Musset’s sign 250 Duroziez’s sign 250 Gerhardt’s sign 251 Hill’s sign 251 Mayne’s sign 251 Müller’s sign 251 Quincke’s sign 251 Traube’s sign 251 Widened pulse pressure 274 Aortic stenosis Left ventricular heave/sustained apical impulse/pressure-loaded apex 170 Displaced apex beat 167 Anacrotic pulse 175 Pulsus parvus 182 Pulsus tardus 182 Ejection systolic murmur 238 Narrow pulse pressure 268 S4 (fourth heart sound) 291 Paradoxical splitting of the heart sounds 297 Aphasia Wernicke’s aphasia 558 Broca’s aphasia 378 Global aphasia 420 Appendicitis McBurney’s point tenderness 620 Obturator sign 625 Rovsing’s sign 640 Psoas sign 636 Atrial septal defect/ventricular septal defect Platypnoea 140 Hyperdynamic/volume-loaded beat 169 Displaced apex beat 167 Pansystolic murmur 237 Splitting heart sounds: widened splitting: fixed 300 Asthma Tachypnoea 151 Respiratory distress signs 117, 126, 133, 134, 140, 153 Cough 104 Wheeze 157 Pulsus paradoxus 277 Dyspnoea 111 Intercostal recession 126 Paradoxical respiration 133 Bronchiectasis Cough 104 Crackles 107 Dyspnoea 111 Hyperventilation 124 Intercostal recession 126 Paradoxical respiration 133 Sputum 145 Contents by Condition Dennis_2371_Contents by Condition_main.indd 9 7/31/2015 3:04:21 PM �� Simpo PDF Password Remover Unregistered Version - http://www.simpopdf.com Contents by Condition x Cardiac tamponade/pericardial effusion Bigeminal pulse 176 Ewart’s sign 203 Jugular venous pressure (JVP): raised 219 JVP: prominent x-descent 228 JVP: absent y-descent 229 Pulsus paradoxus 277 Cerebellar signs Dysdiadochokinesis 399 Dysmetria 401 Dysarthria 397 Hypotonia 452 Truncal ataxia 526 Romberg’s test 503 Pronator drift 492 Chronic renal failure Bruising 669 Uraemic frost 729 Pruritic marks 632 Peripheral oedema 263 Congestive heart failure Cough 104 Wheeze 157 Crackles 107 Tachypnoea 151 Hyperventilation 124 Intercostal recession 126 Orthopnoea 129 Paroxysmal nocturnal dyspnoea 134 Pulsus alternans 178 S3 (third heart sound) 290 Ascites 572 Caput medusae 587 Splenomegaly 646 Displaced apex beat 167 Bigeminal pulse 176 Dicrotic pulse 177 Pulsus alternans 178 Cardiac cachexia 190 Cheyne–Stokes respiration 193 Cyanosis 199 Hepatojugular reflux 204 Hepatomegaly 610 Raised jugular venous pressure 219 Kussmaul’s sign 217 Peripheral oedema 263 Narrow pulse pressure 268 Tachycardia 301 Chronic obstructive pulmonary disease (COPD) Dyspnoea 111 Harrison’s sulcus 119 Tachypnoea 151 Pursed-lip breathing 144 Barrel chest 92 Crackles 107 Wheeze 157 Hyperventilation 124 Clubbing 196 Intercostal recession 126 Paradoxical respiration 133 Hyper-resonance to percussion 137 Vocal fremitus 155 Vocal resonance 156 Breath sounds: reduced 99 Dahl’s sign 110 Cranial nerve signs Visual acuity 532 Oculomotor (CNIII) palsy 467 Trochlear (CNIV) palsy 522 Abducens (CNVI) palsy 351 Facial muscle weakness 407 Gag reflex 414 Relative afferent pupillary defect (Marcus Gunn pupil) 498 Jaw jerk reflex 458 Corneal reflex 393 Tongue deviation 520 Sternocleidomastoid weakness 518 Uvular deviation 528 Hoarseness 432 Dysarthria 397 Hearing impairment 424 Cushing’s syndrome Bruising 669 Central adiposity 673 Buffalo hump 673 Moon facies 673 Striae 651 Hirsutism 692 Plethora 713 Polyuria 716 Proximal myopathy 723 Steroid acne 727 Gynaecomastia 600 Cystic fibrosis Harrison’s sulcus 119 Intercostal recession 126 Sputum 145 Dermatomyositis Shawl sign 49 Gottron’s papules 22 V-sign 64 Proximal myopathy 723 Calcinosis 15 Heliotrope rash 25 Telangiectasia 57 Diabetes Acanthosis nigricans 662 Charcot foot 17 Dennis_2371_Contents by Condition_main.indd 10 7/31/2015 3:04:21 PM �� Simpo PDF Password Remover Unregistered Version - http://www.simpopdf.com Contents by Condition xi Diabetic amyotrophy 675 Diabetic retinopathy 676 Granuloma annulare 686 Necrobiosis lipoidica diabeticorum 708 Polyuria 716 Polydipsia 715 Skin tags 726 Steroid acne 727 Cotton wool spots 209 Xanthelasmata 303 Endocarditis Clubbing 196 Janeway lesions 214 Roth spots 284 Osler’s nodes 259 Splinter haemorrhages 293 Fluid Status Tachycardia 301 Hypotension 703 Capillary return decreased/delayed 188 Passive leg raise 260 Pulse pressure variation 270 Skin turgor: reduced 292 Oliguria 627 Narrow pulse pressure 268 Gait abnormalities Ataxic gait 366 High stepping gait 429 Parkinsonian gait 482 Spasticity 541 Waddling gait 195 Haemochromatosis Hyperpigmentation 696 Heart block Bradycardia 185 Cannon a-waves 222 Hip signs Apparent leg length 5 Patrick’s test (FABER test) 37 Thomas’ test 59 Trendelenburg’s sign 61 True leg length discrepancy 62 Valgus deformity 65 Varus deformity 68 Hypertension Left ventricular heave/sustained apical impulse/pressure-loaded apex 170 Displaced apex beat 167 Av nipping 207 Copper wiring 208 Silver wiring 208 Microaneurysms 210 Retinal haemorrhage 211 Cotton wool spots 209 S4 (fourth heart sound) 291 Hyperthyroidism Gynaecomastia 600 Palmar erythema 629 Goitre 684 Graves’ ophthalmopathy 687 Lid lag 688 Von Graefe’s sign 689 Chemosis 690 Lagophthalmos 689 Abadie’s sign 689 Dalrymple’s sign 689 Griffith’s sign 689 Diplopia 690 Ballet’s sign 690 Proptosis 690 Riesman’s sign 690 Hyperreflexia 444 Hyperthyroid tremor 700 Onycholysis 709 Pemberton’s sign 710 Periodic paralysis 712 Pre-tibial myxoedema 720 Proximal myopathy 723 Vitiligo 730 Hypertrophic obstructive cardiomyopathy Left ventricular heave/sustained apical impulse/pressure-loaded apex 170 Pulsus bisferiens 180 Narrow pulse pressure 268 S4 (fourth heart sound) 291 Apex beat: double or triple impulse 168 Hypocalcaemia Chvostek’s sign 671 Trousseau’s sign 728 Hypothyroidism Goitre 684 Hyporeflexia/delayed ankle jerks 701 Hypotension 703 Macroglossia 706 Pemberton’s sign 710 Proximal myopathy 723 Inflammatory bowel disease Uveitis/iritis 652 Erythema nodosum 596 Mouth ulcer 622 Pyoderma gangrenosum 637 Knee signs Anterior drawer test 2 Apley’s grind test 3 Bulge/wipe/stroke test 12 Crepitus 19 Dennis_2371_Contents by Condition_main.indd 11 7/31/2015 3:04:21 PM �� Simpo PDF Password Remover Unregistered Version - http://www.simpopdf.com Contents by Condition xii Lachman’s test 28 McMurray’s test 32 Patellar apprehension test 35 Patellar tap 36 Valgus deformity 65 Varus deformity 68 Left bundle branch block Paradoxical splitting of heart sounds 297 Leukaemia/lymphoma Lymphadenopathy 332 Gum hypertrophy 325 Splenomegaly 646 Liver disease/cirrhosis Ascites 572 Atrophic testicles 666 Hepatic flap/asterixis 581 Caput medusae 587 Clubbing 196 Gynaecomastia 600 Hepatic encephalopathy 605 Hepatic foetor 608 Jaundice 612 Hepatomegaly 610 Leuconychia 618 Muehrcke lines 623 Palmar erythema 629 Platypnoea 140 Pruritic scratch marks 632 Scleral icterus 641 Spider naevus 644 Splenomegaly 646 Peripheral oedema 263 Lung cancer malignancy: primary or secondary Hypertrophic pulmonary osteoarthropathy 122 Cough 104 Haemoptysis 118 Bronchial breath sounds 98 Crackles 107 Hyperventilation 124 Intercostal recession 126 Pemberton’s sign 710 Sputum 145 Vocal fremitus 155 Vocal resonance 156 Malignancy: other Bone pain 316 Lymphadenopathy 332 Leser–Trélat sign 330 Virchow’s node 336 Neoplastic fever 337 Trousseau’s sign of malignancy 342 Hepatomegaly 610 Sister Mary Joseph nodule 643 Meningitis Brudzinski sign 384 Jolt accentuation 460 Kernig’s sign 461 Photophobia 484 Mitral regurgitation Hyperdynamic/volume-loaded beat 169 Displaced apex beat 167 Pansystolic murmur 237 Right ventricular heave 283 Diminished S1 288 Mitral stenosis Mitral facies 235 Diastolic rumbling murmur 253 Opening snap 254 Narrow pulse pressure 268 Right ventricular heave 283 Accentuated S1 287 Diminished S1 288 Plethora 713 Apex beat: tapping 171 Osteoarthritis Crepitus 19 Boutonnière deformity 10 Heberden’s nodes 9 Bouchard’s nodes 9 Parkinson’s disease Clasp-knife phenomenon 388 Rigidity 501 Cogwheel rigidity 391 Parkinsonian tremor 483 Glabellar reflex/tap 419 Bradykinesia 375 Patent ductus arteriosis Hyperdynamic/volume-loaded beat 169 Displaced apex beat 167 Pulsus bisferiens 180 Continuous/machinery murmur 257 Pericarditis/constrictive pericarditis Kussmaul’s sign 217 Pericardial knock 261 Pericardial rub 262 Pleural effusion Asymmetrical chest expansion 86 Bronchial breath sounds 98 Dyspnoea 111 Intercostal recession 126 Dullness to percussion 136 Breath sounds: reduced 99 Pneumonia Asymmetrical chest expansion 86 Bronchial breath sounds 98 Dennis_2371_Contents by Condition_main.indd 12 7/31/2015 3:04:21 PM �� Simpo PDF Password Remover Unregistered Version - http://www.simpopdf.com Contents by Condition xiii Cough 104 Wheeze 157 Crackles 107 Dyspnoea 111 Hyperventilation 124 Intercostal recession 126 Paradoxical respiration 133 Dullness to percussion 136 Pleural rub 143 Sputum 145 Vocal fremitus 155 Vocal resonance 156 Pneumothorax Hyper-resonance to percussion 137 Vocal fremitus 155 Tachypnoea 151 Dyspnoea 111 Asymmetrical chest expansion 86 Power Weakness: various patterns 545 Muscle wasting 369 Psoriatic arthritis Onycholysis 709 Psoriatic nails 40 Sausage-shaped digits 46 Pulmonary embolus Tachypnoea 151 Cough 104 Dyspnoea 111 Haemoptysis 118 Hyperventilation 124 Intercostal recession 126 Paradoxical respiration 133 Pleural rub 143 Right ventricular heave 283 Tachycardia 301 Pulmonary fibrosis Crackles 107 Dyspnoea 111 Tachypnoea 151 Cough 104 Harrison’s sulcus 119 Hyperventilation 124 Intercostal recession 126 Pulmonary hypertension Raised jugular venous pressure 219 S2 loud 289 Right ventricular heave 283 Kussmaul’s sign 217 Giant a-waves 224 Large v-waves 226 Graham Steell murmur 252 Split S1 294 Pulmonary regurgitation Diastolic murmur 255 Pulmonary stenosis Ejection systolic murmur 238 Right ventricular heave 283 Split S1 294 Reflexes Jaw jerk reflex 458 Gag reflex 414 Crossed-adductor reflex 396 Corneal reflex 393 Grasp reflex 422 Palmomental reflex 479 Glabellar reflex/tap 419 Hyperreflexia 444 Hyporeflexia and areflexia 447 Renal failure Gynaecomastia 600 Leuconychia 618 Pruritic marks 632 Rheumatoid arthritis Subcutaneous rheumatoid nodules 52 Swan-neck deformity 55 Ulnar deviation 63 Pleural friction rub 143 Right bundle branch block Split S1 294 Scleroderma Sclerodactyly 48 Telangiectasia 57 Splinter haemorrhages 293 Calcinosis/calcinosis cutis 15 Sensation Sensory level 505 Sensory loss patterns 507 Sepsis Bigeminal pulse 176 Dicrotic pulse 177 Widened pulse pressure 274 Mottling 236 Shoulder signs Apley’s scratch test 4 Apprehension test (crank test) 7 Apprehension–relocation test (Fowler’s test) 8 Dropped arm test 20 Hawkins’ impingement sign/test 23 Neer’s impingement sign 33 Speed’s test 51 Sulcus sign 53 Dennis_2371_Contents by Condition_main.indd 13 7/31/2015 3:04:21 PM �� Simpo PDF Password Remover Unregistered Version - http://www.simpopdf.com Contents by Condition xiv Supraspinatus test (empty-can test) 54 Yergason’s sign 70 Solid malignancies Bone pain 316 Lymphadenopathy 332 Leser–Trélat sign 330 Virchow’s node 336 Neoplastic fever 337 Trousseau’s sign of malignancy 342 Hepatomegaly 610 Petechiae 322 Ecchymoses 322 Purpura 322 Surgical signs McBurney’s point tenderness 620 Obturator sign 625 Rovsing’s sign 640 Psoas sign 636 Rigidity and guarding 639 Murphy’s sign 624 Bowel sounds 582 Sister Mary Joseph nodule 643 Rectal mass 341 Systemic lupus erythematosus Mouth ulcer 622 Butterfly rash 13 Telangiectasia 57 Calcinosis 15 Livedo reticularis 29 Pleural friction rub 143 Raynaud’s syndrome 42 Tone Clasp-knife phenomenon 388 Hypotonia 452 Myotonia 465 Spasticity 516 Tremor Essential tremor 405 Intention tremor 454 Parkinsonian tremor 483 Physiological tremor 486 Tricuspid regurgitation Large v-wave 226 Raised jugular venous pressure 219 Absent x-descent of jugular venous pressure 227 Pansystolic murmur 237 Tachycardia 301 Tricuspid stenosis Diastolic murmur 256 Vision defects/neurological eye signs Visual acuity 532 Altitudinal scotoma 536, 537 Bitemporal hemianopia 537 Central scotoma 537, 539 Tunnel vision 537 Homonymous hemianopia with macular sparing 537, 539 Homonymous hemianopia 537 Homonymous quadrantanopia 537 Horner’s syndrome 437 Ptosis 495 Papilloedema 480 Photophobia 484 Orbital apex syndrome 476 Optic atrophy 474 Internuclear ophthalmoplegia 456 Relative afferent pupillary defect (Marcus Gunn pupil) 498 Pinpoint pupils 487 Light–near dissociation (Argyll Robertson pupil) 363 Anisocoria 355 Dennis_2371_Contents by Condition_main.indd 14 7/31/2015 3:04:21 PM �� Simpo PDF Password Remover Unregistered Version - 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