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.
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Assist. prof. Safaa AliFICMS (med.)College of Medicine / Kufa University2009
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]
8
Moon face with hirsutism[Cushing syndrome]
9
Coarse features of the face and bulky hands
[Acromegaly]
10
Proganthism (protrusion of lower jaw)
[Acromegaly]
11
Puffy eyes[nephrotic syndrome,
hypothyroidism]
12
Xanthelasma [hypercholesterolemia]
13
Heliotrope rash (purple discoloration on the upper
eyelids) [dermatomyositis]
14
Pallor of conjunctiva[anemia]
15
Yellowish discoloration of the sclera and skin
[jaundice]
16
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]
23
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 ]
33
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 ]
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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)
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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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