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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. This atlas also contains movies that demonstrate the clinical examination of the neck, chest, heart, abdomen and nervous system. (cont.)*
* Preface
I have no authority for any of these slides but I had collected them from different websites and added my notes. To open any chapter click on its title in the content. The title of the slide has been hidden for self assessment. To reveal the title click on the slide. Assist. prof. Safaa Ali FICMS (med.) College of Medicine / Kufa University 2009 safaaali65@yahoo.comContents
1. Physical signs 2. Clinical examination*
Lid retraction[Thyrotoxicosis]
*Lid lag[Thyrotoxicosis]
*
Exophthalmos[Grave’s disease] *
Puffy apathetic face with coarse hair[Hypothyroidism, before and after treatment]*
Moon face with hirsutism[Cushing syndrome]
*Coarse features of the face and bulky hands [Acromegaly]
*Proganthism (protrusion of lower jaw)[Acromegaly]
*Puffy eyes[nephrotic syndrome, hypothyroidism]
*Xanthelasma [hypercholesterolemia]
*Heliotrope rash (purple discoloration on the upper eyelids) [dermatomyositis]
*
Pallor of conjunctiva[anemia]
*Yellowish discoloration of the sclera and skin[jaundice]
*Kayser fleischer ring[Wilson’s disease] *
Kayser fleischer ring[Wilson’s disease] *Red painful eye(anterior uveitis) [Behcet disease, Reiter's syndrome, IBD]
*Infiltration of lower eye lid [Lymphoma]
*Discoid lupus lesion[SLE]
*Saddle nose[Wegner granulomatosis]
*
Ulcer with rolled borders[basal cell carcinoma]
*Hyperpigmented elevated lesion[malignant melanoma]
*Papules, pustules and comedones [Acne vulgaris] (adolescence, steroid therapy)
*Whitehead and blackhead comedones[Acne vulgaris] (adolescence, steroid therapy)
*Melasma (symmetric brown patches on the face)[pregnancy, oral contraceptive]
*erythematous plaque over the nose (butterfly rash) [SLE]
*Papules, pustules and telangiectasia on erythematous plaque[acne rosacea]
*
Multiple angiofibroma[tuberous sclerosis]
*Maculopapular rash[measles, drug eruption]
*Maculopapular rash behind the ear[measles]
*Erythema and edema of the face[Erysipelas / streptococcal infection ]
*Periorbital edema[angioedema, hereditary or IgE dependent]
*Unilateral ptosis[Congenital, Myasthenia gravis]
*Bilateral ptosis{before and after edrophonium (tensilon) test} [Myasthenia gravis]
*
Ptosis, divergent squint and dilated pupil [Oculomotor nerve palsy]
*Enophthalmos, ptosis and meiosis [Horner’s syndrome] *
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)] *Flat nasolabial fold and inability to show teeth in the right side[right UMN facial nerve palsy]
*
Chvostek's sign [hypoparathyroidism]
*Scattered hemorrhage, yellow exudates and new vessels formation near optic disc[proliferative diabetic retinopathy]
*
Scattered hemorrhage and cotton wool spots (retinal infarcts)[hypertensive retinopathy]
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Massive retinal hemorrhage [central retinal vein occlusion]
*
Papilloedema [raised intracranial pressure]
*Optic atrophy[optic neuropathies]
*Pallor of the lips[anemia]
*Bluish discoloration of the lips[central cyanosis]
*Confluent vesicles on the lips [Herpes simplex infection]
*Dark brown spots on the lips[Peutz- Jegher’s disease] *
Aphthous ulcer[idiopathic, Behcet disease, IBD, HIV infection]*
Swelling of the lip[angioedema, hereditary or IgE dependent]
*
Gum hyperpigmentation[Addison’s disease] *
Gum hypertrophy[calcium channel blockers, Phenytoin therapy and AML M5]*
Buccal hyperpigmentation[Addison’s disease] *
Multiple aphthous ulcers[idiopathic, Behcet disease, IBD, HIV infection]*
White patches of oral mucosa [Candida albicans infection]
*Tonsillar enlargement [Tonsillar abscess]
*Dry tongue[dehydration]
*Swelling of the tongue[angioedema, hereditary or IgE dependent]
*
Atrophic glossitis[B12 and iron deficiency]
*Herpes glossitis [Herpes simplex infection]
*White patches on the tongue [Candida albicans infection]
*White plaques on the tongue [Leukoplakia /Epstein Barr virus infection]
*High arched palate [Marfan syndrome]
*Unequal lower teeth [fracture mandible]
*Left parotid enlargement[Sjogren’s syndrome] *
Right parotid enlargement[mumps]
*Cervical lymph node enlargement[lymphoma]
*Supraclavicular lymph node enlargement (Virchow's node)[gastric cancer]
*Multinodular goiter[simple multinodular goiter]
*Multinodular goiter[simple multinodular goiter]
*Clubbing and cyanosis[cyanotic congenital heart diseases]
*Clubbing [bronchogenic cancer]
*Koilonychia (spooning of nail)[iron deficiency anemia]
*
Beau’s lines[chemotherapy, transient medical illness] *
Central nail canal[peripheral vascular disease]*
Nail beading[DM, endocrine disorders]
*Nail pitting[psoriasis]
*Leukonychia (white nail)[liver cirrhosis, CRF]
*Yellow nail[yellow nail syndrome](pleural effusion and bronchiectasis)
*Splinter hemorrhage[trauma, vasculitis, bacterial endocarditis]
*Paronychia [bacterial or fungal infection]
*
Swelling of the right hand[angioedema, hereditary or IgE dependent]
*Fingers cyanosis[Raynaud’s phenomena] *
Digital infarction[DIC, vasculitis, sever Raynaud’s disease] *Palmar erythema[liver disease, thyrotoxicosis, pregnancy and fever]
*Depigmentation of skin[vitiligo with possible associated autoimmune diseases]
*Palmar xanthoma[familial hypercholesterolemia]
*Tendon xanthoma of thumb[familial hypercholesterolemia]
*Tuberous xanthoma[familial hypercholesterolemia]
*
Carpal spasm[hypocalcemia]
*Trousseau's signs[hypocalcemia]
*Thick tight skin[scleroderma]
*Flexion contractures[scleroderma]
*Limited extension of fingers[scleroderma, DM]
*Dupuytren's contracture [alcoholic liver disease, DM, idiopathic fibrosis]
*Hypermobility of the joints[Ehlers - Danlos syndrome]
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Long fingers (arachnodactyly)[Marfan syndrome]
*Long arm span[Marfan syndrome]
*Heberden's nodes[osteoarthritis]
*Swan neck deformity[rheumatoid arthritis]
*Boutonniere deformity[rheumatoid arthritis]
*Z-deformity of the thumb[rheumatoid arthritis]
*Rheumatoid nodule[rheumatoid arthritis]
*
Warts [Papillomavirus infection]
*Extradactyly and syndactyly [Laurence –Moon- Biedl syndrome] *
Short fourth metacarpal bone [Pseudohypoparathyroidism]*
Erythematous plaques with adherent silvery scale.[psoriasis]
*Pathergy test[Behcet’s disease] *
Lipodystrophy[insulin therapy]*
Eruptive xanthoma[hypertriglyceridemia]
*Hyperpigmented lesions[diabetic dermopathy]
*
*
Erythema nodosum[ TB, streptococcal infection, IBD, sarcoidosis, OC]
*Erythema ab igne[local heat effect]
*Necrobiosis lipoidica diabeticorum[DM]
*Pyoderma gangrenosum[idiopathic, IBD, chronic active hepatitis, RA, CML]
*Swelling and redness of the right leg[acute DVT]
*Swelling and redness of the left leg[extensive DVT]
*Hoffman’s sign[acute DVT] *
Swelling and redness of the leg[cellulitis]
*Bilateral leg edema[heart failure, nephrotic syndrome, liver cirrhosis]
*Unilateral leg edema[lymphatic obstruction]
*Swelling behind the right knee [Baker cyst /RA]
*Varicose veins[primary or secondary to deep venous insufficiency ]
*Swelling and redness of the varicose vein[superficial thrombophlebitis]
*Stasis dermatitis with ulcer[chronic venous insufficiency]
*Foot ulcer and amputation of toes[DM]
*
Blisters and ulcer of the foot[DM]
*Dry gangrene[DM]
*Bony abnormality and nail infection[DM]
*Interdigital infection[DM]
*Swelling and redness of 1st MP joint [acute gouty arthritis]
*Skin hyperpigmentation[Addison's disease]
*Achilles tendon xanthoma [familial hypercholesterolemia]
*
Hammer toe[DM]
*Pes cavus (high arched foot)[Friedreich's Ataxia, Charcot-Marie-Tooth neuropathy, muscular dystrophy]
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Spider nevi[chronic liver disease]
*Purplish striae[Cushing syndrome, recent weight gain]
*Velvety hyperpigmentation of axilla (Acanthosis nigricans)[obesity, acromegaly, insulin resistance, GI malignancy]
*
Gynecomastia [puberty, liver disease, drugs like cimetidine, digoxin and spironolactone]
*Loss of male hair distribution[hypogonadism: hypothalamic-pituitary disorders, testicular disease, liver cirrhosis]
*
Dilated superficial veins[superior vena cava obstruction]
*Pectus carinatum[congenital, Marfan syndrome]
*Pectus carinatum[congenital, Marfan syndrome]
*Barrel chest[chronic obstructive lung diseases]
*Scoliosis [congenital, Marfan syndrome]
*Ascites [liver cirrhosis, nephrotic syndrome, heart failure, TB peritonitis, malignancy]
*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]
*Purplish abdominal striae[Cushing syndrome]
*Maculopapular rash[viral infections like measles, drug allergy]
*vesicular eruption of variable stages[Varicella (chicken pox)]
*Unilateral vesicular eruption[Herpes zoster(shingles)]
*Urticaria [drug allergy, physical urticaria, hereditary urticaria and vasculitis ]
*Blisters over the abdomen[Bullous pemphigoid ]
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Erythema multiformi[drug allergy, herpes and Mycoplasma infection ]
*Scaly lesion with central healing and peripheral inflammation[Tinea (ring worm) /fungal infection]
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Erythematous papules in the trunk[cherry hemangioma]
**
Lipoatrophy [local complication of insulin injection]
*Wasting of face and neck muscles/frontal baldness[myotonic dystrophy]
*Gower’s sign[Duchenne muscular dystrophy] * A
BC
D
Muscle wasting and contracture[Duchenne muscular dystrophy]
*Short stature and obesity[Cushing syndrome in children]
*Dwarfism [achondroplasia]
*Gigantism [GH excess before puberty]
*Clinical examination
* Neck examination. Chest examination. Cardiac examination. Abdominal examination. Neurological examination.Examination of the neck
Lymph nodes. Thyroid. Carotid pulsation. JVP.* Click on the screen
Examination of the chest
Inspection. Palpation. Percussion. Auscultation.
* Click on the screen
Examination of the precordium
Inspection. Palpation. Percussion. Auscultation.* Click on the screen
Examination of the abdomen
Inspection. Palpation & percussion of the abdominal wall. Palpation & percussion of the liver & spleen. Palpation of aorta. Auscultation.* Click on the screen
Examination of the cranial nerves
General observation. Examination for meningeal signs. Examination of each cranial nerve.* Click on the screen
Examination of the motor system
Inspection. Tone. Power. Reflexes. Coordination.* Click on the screen
Examination of the sensory system
Pain. Temp. Light touch. Vibration. Position. Romberg test.* Click on the screen