Atlas of Physical Signs

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Transcript of Atlas of Physical Signs

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Preface

The aim of this atlas is to help the medical students in the detection and interpretation of the physical signs of various medical diseases.

I have no authority for any of these slides but I had collected them from different websites and added my notes.

(cont.)

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Preface The title of the slide has been hidden for

self assessment. To reveal the title click on the slide.

Assist. prof. Safaa AliFICMS (med.)College of Medicine / Kufa University2009

drsafaa65@gmail.com

Lid retraction[Thyrotoxicosis]

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Lid lag[Thyrotoxicosis]

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Exophthalmos[Grave’s disease]

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Puffy apathetic face with coarse hair

[Hypothyroidism, before and after treatment]

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Moon face with hirsutism[Cushing syndrome]

9

Coarse features of the face and bulky hands

[Acromegaly]

10

Proganthism (protrusion of lower jaw)

[Acromegaly]

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Puffy eyes[nephrotic syndrome,

hypothyroidism]

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Xanthelasma [hypercholesterolemia]

13

Heliotrope rash (purple discoloration on the upper

eyelids) [dermatomyositis]

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Pallor of conjunctiva[anemia]

15

Yellowish discoloration of the sclera and skin

[jaundice]

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Kayser fleischer ring[Wilson’s disease]

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Kayser fleischer ring[Wilson’s disease]

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Red painful eye(anterior uveitis) [Behcet disease, Reiter's syndrome,

IBD]

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Infiltration of lower eye lid [Lymphoma]

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Discoid lupus lesion[SLE]

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Saddle nose[Wegner granulomatosis]

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Ulcer with rolled borders[basal cell carcinoma]

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Hyperpigmented elevated lesion[malignant melanoma]

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Papules, pustules and comedones [Acne vulgaris]

(adolescence, steroid therapy)

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Whitehead and blackhead

comedones[Acne vulgaris]

(adolescence, steroid therapy)

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Melasma (symmetric brown patches on the

face)[pregnancy, oral contraceptive]

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erythematous plaque over the nose (butterfly rash)

[SLE]

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Papules, pustules and telangiectasia on erythematous

plaque[acne rosacea]

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Multiple angiofibroma[tuberous sclerosis]

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Maculopapular rash[measles, drug eruption]

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Maculopapular rash behind the ear[measles]

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Erythema and edema of the face[Erysipelas / streptococcal infection ]

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Periorbital edema[angioedema, hereditary or IgE

dependent]

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Unilateral ptosis[Congenital, Myasthenia gravis]

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Bilateral ptosis{before and after edrophonium

(tensilon) test} [Myasthenia gravis]

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Ptosis, divergent squint and dilated pupil

[Oculomotor nerve palsy]

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Enophthalmos, ptosis and meiosis [Horner’s syndrome]

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Inability to elevate the left eyebrow and incomplete closure of left eye with Bell’s

phenomena. Right side deviation of the mouth

[left LMN facial nerve palsy (Bell’s palsy)]

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Flat nasolabial fold and inability to show teeth in the right side

[right UMN facial nerve palsy]

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Chvostek's sign [hypoparathyroidism]

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Scattered hemorrhage, yellow exudates and new vessels formation near optic disc

[proliferative diabetic retinopathy]

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Scattered hemorrhage and cotton wool spots (retinal infarcts)[hypertensive retinopathy]

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Massive retinal hemorrhage [central retinal vein occlusion]

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Papilloedema [raised intracranial pressure]

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Optic atrophy[optic neuropathies]

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Pallor of the lips[anemia]

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Bluish discoloration of the lips[central cyanosis]

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Confluent vesicles on the lips [Herpes simplex infection]

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Dark brown spots on the lips[Peutz- Jegher’s disease]

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Aphthous ulcer[idiopathic, Behcet disease, IBD, HIV

infection]

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Swelling of the lip[angioedema, hereditary or IgE

dependent]

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Gum hyperpigmentation[Addison’s disease]

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Gum hypertrophy[calcium channel blockers,

Phenytoin therapy and AML M5]

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Buccal hyperpigmentation[Addison’s disease]

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Multiple aphthous ulcers[idiopathic, Behcet disease, IBD, HIV

infection]

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White patches of oral mucosa [Candida albicans infection]

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Tonsillar enlargement [Tonsillar abscess]

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Dry tongue[dehydration]

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Swelling of the tongue[angioedema, hereditary or IgE

dependent]

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Atrophic glossitis[B12 and iron deficiency]

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Herpes glossitis [Herpes simplex infection]

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White patches on the tongue [Candida albicans infection]

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White plaques on the tongue [Leukoplakia /Epstein Barr virus

infection]

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High arched palate [Marfan syndrome]

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Unequal lower teeth [fracture mandible]

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Left parotid enlargement[Sjogren’s syndrome]

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Right parotid enlargement[mumps]

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Cervical lymph node enlargement[lymphoma]

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Supraclavicular lymph node enlargement

(Virchow's node)[gastric cancer]

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Multinodular goiter[simple multinodular goiter]

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Multinodular goiter[simple multinodular goiter]

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Clubbing and cyanosis[cyanotic congenital heart

diseases]

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Clubbing [bronchogenic cancer]

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Koilonychia (spooning of nail)[iron deficiency anemia]

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Beau’s lines[chemotherapy, transient medical

illness]

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Central nail canal[peripheral vascular disease]

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Nail beading[DM, endocrine disorders]

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Nail pitting[psoriasis]

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Leukonychia (white nail)[liver cirrhosis, CRF]

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Yellow nail[yellow nail syndrome](pleural effusion and

bronchiectasis)

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Splinter hemorrhage[trauma, vasculitis, bacterial

endocarditis]

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Paronychia [bacterial or fungal infection]

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Swelling of the right hand[angioedema, hereditary or IgE

dependent]

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Fingers cyanosis[Raynaud’s phenomena]

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Digital infarction[DIC, vasculitis, sever Raynaud’s

disease]

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Palmar erythema[liver disease, thyrotoxicosis, pregnancy and

fever]

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Depigmentation of skin[vitiligo with possible associated autoimmune

diseases]

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Palmar xanthoma[familial hypercholesterolemia]

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Tendon xanthoma of thumb[familial hypercholesterolemia]

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Tuberous xanthoma[familial hypercholesterolemia]

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Carpal spasm[hypocalcemia]

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Trousseau's signs[hypocalcemia]

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Thick tight skin[scleroderma]

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Flexion contractures[scleroderma]

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Limited extension of fingers[scleroderma, DM]

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Dupuytren's contracture [alcoholic liver disease, DM, idiopathic

fibrosis]

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Hypermobility of the joints[Ehlers - Danlos syndrome]

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Long fingers (arachnodactyly)[Marfan syndrome]

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Long arm span[Marfan syndrome]

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Heberden's nodes[osteoarthritis]

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Swan neck deformity[rheumatoid arthritis]

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Boutonniere deformity[rheumatoid arthritis]

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Z-deformity of the thumb[rheumatoid arthritis]

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Rheumatoid nodule[rheumatoid arthritis]

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Warts [Papillomavirus infection]

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Extradactyly and syndactyly [Laurence –Moon- Biedl syndrome]

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Short fourth metacarpal bone [Pseudohypoparathyroidism]

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Erythematous plaques with adherent silvery scale.

[psoriasis]

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Pathergy test[Behcet’s disease]

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Lipodystrophy[insulin therapy]

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Eruptive xanthoma[hypertriglyceridemia]

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Hyperpigmented lesions[diabetic dermopathy]

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Purpura [thrombocytopenia, Henoch-Schönlein

purpura]

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Erythema nodosum[ TB, streptococcal infection, IBD,

sarcoidosis, OC]

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Erythema ab igne[local heat effect]

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Necrobiosis lipoidica diabeticorum[DM]

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Pyoderma gangrenosum[idiopathic, IBD, chronic active hepatitis,

RA, CML]

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Swelling and redness of the right leg

[acute DVT]

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Swelling and redness of the left leg[extensive DVT]

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Hoffman’s sign[acute DVT]

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Swelling and redness of the leg[cellulitis]

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Bilateral leg edema[heart failure, nephrotic syndrome, liver

cirrhosis]

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Unilateral leg edema[lymphatic obstruction]

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Swelling behind the right knee [Baker cyst /RA]

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Varicose veins[primary or secondary to deep venous

insufficiency ]

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Swelling and redness of the varicose vein

[superficial thrombophlebitis]

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Stasis dermatitis with ulcer[chronic venous insufficiency]

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Foot ulcer and amputation of toes[DM]

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Blisters and ulcer of the foot[DM]

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Dry gangrene[DM]

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Bony abnormality and nail infection[DM]

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Interdigital infection[DM]

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Swelling and redness of 1st MP joint

[acute gouty arthritis]

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Skin hyperpigmentation[Addison's disease]

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Achilles tendon xanthoma [familial hypercholesterolemia]

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Hammer toe[DM]

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Pes cavus (high arched foot)[Friedreich's Ataxia, Charcot-Marie-Tooth

neuropathy, muscular dystrophy]

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Spider nevi[chronic liver disease]

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Purplish striae[Cushing syndrome, recent weight

gain]

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Velvety hyperpigmentation of axilla (Acanthosis nigricans)

[obesity, acromegaly, insulin resistance, GI malignancy]

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Gynecomastia [puberty, liver disease, drugs like

cimetidine, digoxin and spironolactone]

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Loss of male hair distribution[hypogonadism: hypothalamic-pituitary disorders, testicular

disease, liver cirrhosis]

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Dilated superficial veins[superior vena cava obstruction]

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Pectus carinatum[congenital, Marfan syndrome]

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Pectus excavitum[congenital, Marfan syndrome]

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Barrel chest[chronic obstructive lung diseases]

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Scoliosis [congenital, Marfan syndrome]

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Ascites [liver cirrhosis, nephrotic syndrome,

heart failure, TB peritonitis, malignancy]

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Caput medusa(dilated peri-umbilical veins)

[liver cirrhosis with portal hypertension]

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Dilated superficial veins with upwards flow

[inferior vena cava obstruction]

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Purplish abdominal striae[Cushing syndrome]

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Maculopapular rash[viral infections like measles, drug

allergy]

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vesicular eruption of variable stages

[Varicella (chicken pox)]

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Unilateral vesicular eruption[Herpes zoster(shingles)]

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Urticaria [drug allergy, physical urticaria, hereditary urticaria and vasculitis ]

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Blisters over the abdomen[Bullous pemphigoid ]

157

Erythema multiformi[drug allergy, herpes and Mycoplasma

infection ]

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Scaly lesion with central healing and peripheral inflammation[Tinea (ring worm) /fungal

infection]

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Erythematous papules in the trunk[cherry hemangioma]

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Neurofibromas and café au lait spots

[neurofibromatosis type 1] (Von Recklinghausen's disease)

161

Lipoatrophy [local complication of insulin

injection]

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Wasting of face and neck muscles/frontal baldness

[myotonic dystrophy]

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Gower’s sign[Duchenne muscular dystrophy]

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A

B

C

D

Muscle wasting and contracture[Duchenne muscular dystrophy]

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Short stature and obesity[Cushing syndrome in children]

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Dwarfism [achondroplasia]

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Gigantism [GH excess before puberty]

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