SIGNS IN MEDICINE---IMP LIST

(A)- Aarons sign seen in appendicitis. On firm pressure over the McBurneys pointthe patient with appendicitis will feel distress in the epigastrium orprecordial region.

- Abadiesign - This is the test of Muscle sense .Compress or squeeze bigmuscle bellies (calf,` triceps or biceps)and note whether the patient complainsof pain (Abadiesign ).This is the test of pressure sense too.

- Adlers sign- Is seen in Ectopic pregnancy .The abdominal tenderness is fixed,even when the patient is turned from side to side.

- Albright sign-Metacarpels are shortened in pseudohypoparathyroidism , nevoidbasal cell carcinoma ,turner and Larsen .In the presence of short fourthmetacarpal ,there will be a dimple at the metacarpophalangeal joint.

- Alfred Demusset sign- Bobbing of the head with each heart beat. The rapidblood flow in the carotids will push the head with each beat, thus leading tomovement of head up and down with each heart beat.

- Allis sign- is seen in developmental dysplasia.

- Arm drop sign- sign suggestive of complete tear of the rotator cuff.

- Antenna sign- seen in Keratosis pilaris

- Anterior drawer sign-(Bon bruise sign) for anterior cruciate ligament tear.It is used to diagnose rupture of the cruciate ligaments .The knee should beflexed at a right angle and the upper part of the tibia is pulled forward andpushed backward. Increased anterior and posterior movements will indicate therupture of cruciate ligaments.

- Asboe Hansen sign- (Bulla spread sign) seen in Pemphigus

- Auenbruggers sign-In pericardial effusion ,an epigastric prominence is seen.

- Auspitzs sign-When the scales of Psoriasis are removed ,pin point bleedingspots will be seen .(B)

- Babinskis sign- By stroking the lateral aspect of the dorsum of the foot.There is contraction of tibialis anterior, hamstrings, and tensor fascia lata.

- Baccellis sign-Good conduction of whisper in non purulent pleural effusion.

- Balls sign- is seen in fetal death .There will be hyperflexion of the spine.

- Ballance sign-The dullness can be elicited on both sides in rupture of spleen.On the right side there will be shift of the dullness ,but it is constant onthe left side.

- Ballentyne-Runge sign - Decrease in the abdominal circumference late inpregnancy due to placental insufficiency

- Banana sign the frontal lobes will be concave .This is due to neural tubedefects

- Barbers chair sign in multiple sclerosis. An electric shock like sensationwhich radiates in to the arms., down the back to the legs, when the patientflexes the head..

- .Barlows sign- Von Rosens sign In congenital instability of the hip jointthe hips are held flexed and abducted , A click can be heard when the femoralhead leaves the acetabulum

- Bastedos sign seen in chronic appendicitis. On inflation of the colon withair ,pain and tenderness will be present in the right iliac fossa.

- Battles sign-blood pigment stain behind the ear over the mastoid due tobasal skull fracture (Sphenoid bone )

- Beak sign - in patients with Hypertrophic pyloric stenosis. ,abrupt cut of thebarium column in the pylorus.

- Beak sign in renal arteriogram-Renal cyst.

- Becker's sign - Pulsations seen in the retinal artery.

- Beevors sign-in patients with paralysis of lower part of rectus abdominis the umbilicus will move upwards when the rising test is performed. The umbilicuswill move downwards in paralysis of upper part of rectus abdominis

- Beheaded scottish terrior sign- Spondylolisthesis.(In oblique view)

- Belly dancers sign- It is seen in unilateral diaphragmatic paralysis .Duringinspiration the umbilicus shifts upward and toward the side of the paralyseddiaphragm

- Bendas sign- This is of importance in tuberculous meningitis. Here the childhas spasm of the trapezius muscle with the result that the shoulder on affectedside is raised up and at times also brought forward. The sign is elicited byturning the head and chin to one side and if there is upward and forward liftingof the shoulder the sign is positive. It may be positive on one or both sides.

- Bergara Warten Berg sign-Loss of vibration on elevation of the closed uppereyelid. It is the earliest sign of facial nerve paralysis.

-Bergman sign (Chalice sign)-is a finding in renal imaging studies where thereis dilatation of ureter distal to a neoplasm. Such dilatation will beabsent in calculus or thrombus.

- Bing sign Pricking the dorsum of foot by a pin produces extensor response.

-Blue berry muffin sign- is seen in dermal metastases of Neuroblastoma .Therewill be raised purple skin lesions.

- Blue dot sign-is seen in torsion of appendix testis .The appendix that hasundergone torsion may be visible through the scrotal skin.

- Blumbergs sign Rebound tenderness. It is seen in acute appendicitis.

- Boas sign- is helpful in differentiating acute cholecystitis from otherconditions. In acute cholecystitis there is a referred pain to the rightscapula. There is an area of hyperaesthesia between the ninth and the eleventhribs posteriorly on the right side..

- Bows sign-Seen in septicemia in infants. The right side of the mediastinalshadow resembles a bow.

- Bow string sign-is used in lumbar disc herniation. It is a variation ofstraight leg raising test. When the leg is raised pain will occur. At the pointof pain, the knee will be flexed which will reduce the pain.

- Branhams sign- (see Nicoladonis sign) is seen in aretrio venous fistula .Theswelling due to arteriovenous fistula disappears on applying pressure on theartery proximal to the fistula, thrill and bruit will decrease and the pulserate fall .the pulse pressure will return to normal.

- Brim sign- is seen in Pagets disease.

- Braxton Hicks sign-Intermittent uterine contractions can be detected bypalpation after 16 weeks of gestation in pregnancy.

- Brudzinskis sign is seen in meningitisFlexion of one lower limb causes flexion of opposite limb immediately. It isthe leg sign.Flexion of neck produces flexion of hips and knees. This is the neck sign.(Brudzinskis neck Sign-Both the lower limbs should be in extended position,with full flexion of the neck, the child flexes both his lower limbs, at thehips as well as knees. This is a common sign of meningitis in infancy. Theremay be minimum flexion of the lower limbs when the child has paraplegia orquadriplegia; there is unilateral flexion of the unaffected limb. This not onlyhelps in the diagnosis of meningitis but also in the diagnosis of hemi paresis.Brudzinskis leg sign- Here one of the lower limbs is flexed to 45 at the hipand 90-120 at knee. While trying to extend the lower limbs there is flexion ofthe opposite limb at the hip and knee. This is a positive Brudzinskis legsign. In children who are constantly moving the lower limbs, particularly inthe first 2-3 years of life, the test should be carried out 3 to 4 times beforeit is concluded as positive. If a child has weakness or paralysis of theopposite limb there may be minimum flexion at the hip and knee.)

- Bruns sign- Excruciating headache , vertiginous episodes , coma and deathdue to sudden movement of the head ,if the cysts are present in the fourthventricle .

- Bryants sign-in shoulder dislocation .Abnormal position of axillary folds.

- Bulge sign- Small effusion in the knee joint. Apply gentle pressure first onthe medial side of the joint when the patient is lying with the quadricepsrelaxed. Watch for the bulge on the lateral side.

-Button hole sign- is seen in Neurofibromatosis(C)

- Capeners sign- is seen in slipped epiphysis .Normally, the posterioracetabular margin will cut across the medial corner of the metaphysis. In thiscondition the entire metaphysis will remain lateral to the posterior acetabularmargin.

- Cardarellis sign- transverse pulsation in the laryngotracheal tube inaneurysms and dilatation of the aortic arch.

- Carmans Meniscus sign- A radiological finding seen in malignant gastriculcer. Meniscus shaped gastric ulcer with the concavity pointed towards thegastric lumen

- Carpet tacks sign- is seen in Discoid Lupus Erythematosis (DLE)

- Carvallos sign- In cases with ASD, the tricuspid murmur is maximal at thelower sternal edge and increases in intensity during inspiration

- Cerebriform tongue sign-is seen in Pemphigus vegetans

- Chaddocks sign seen in pyramidal tract lesion. Extensor response is seenafter striking the skin around the lateral malleolus in a circular fashion.

- Champagne flute sign-due to portal air in NNEC.

- Chandeliers sign-is seen in Gonorrhoea in women

- Circumflex`sign-the metaphysis have some flaring and may appear V-shaped inachondroplasia.

- Chvosteks sign -The facial nerve is tapped at its exit from the stylomastoidforamen. This leads to brief twitching of the facial muscles, ala of the noseand the blinking of the eyelids. .Elevation of the corner of mouth may b e seen.

- Coffee bean sign- Strangulation of incompletely obstructed loop of smallbowel.

- Coin test-is found in tense Pneumothorax. Place a metallic coin on the upperpart of the affected chest, and percuss over the coin with another coin. Listenat the same time from the back with the diaphragm of a stethoscope. A highpitched tympanitic bell-like metallic sound can be heard in the presence ofPneumothorax.

- Colemans sign- Hematoma over the floor of the mouth in fracture of body ofmandible.

- Combys sign-is seen in measles. In early stages thin whitish patches are seenon the gums and buccal mucous membranes.

- Commandos sign-in spastic cerebral palsy the child drags the feet like arudder.

- Coopers sign- In acute appendicitis, the tenderness is elicited in the leftlateral position.

- Corners sign- seen in scurvy. A groove will be present just above the zone ofprovisional calcification.

- Corrigan's sign - Dancing carotids in aortic regurgitation..

- Counting sign-in diaphragmatic paralysis ,the patient cannot count more than10 in one breath.

- Coupdongue sign- Tinea versicolor.

- Courvoisier sign- Gall bladder will be palpable in patients with carcinomahead of the pancreas.

- Crack pot sign- see Macewen sign

- Crescent sign-In hydronephrosis, crescents of contrast medium seen with in the

enlarged renal parenchyma. This is due to the contrast medium circulating in thecollecting ducts compressed by the dilated calyces.

- Crowes sign In neurofibromatosis , axillary freckling and speckledhyperpigmentation over the upper chest ,groin and perineal region will bepresent .

- Cruveilhier s sign-is seen in portal hypertension. Caput medusa due toportocaval anastomosis.

- Cullen sign-A bluish discoloration seen around the umbilicus in patients withacute hemorrhagic pancreatitis.

- Curtsy sign is seen in Sham or Urge syndrome

- Czernys sign-The abdomen normally bulges at the beginning of inspiration. But in patients with chorea, there is paradoxical retraction..(D)

- Dagger sign-is due to ossification of supraspinous and interspinous ligaments in Ankylosing spondylitis . On frontal radiograph a single radio dense linewill be seen.

- Dance sign- in intussusception. The right lower quadrant may feel empty topalpation in intussusception.

- Darier sign- Urticaria pigmentosa. The lesions tend to become red, itchy andurticarial if they are rubbed.

- Dalrymple sign-(Lid retraction) Staring appearance due to abnormal wideningof palpebral fissures in hyperthyroidism

- Dawbarns sign- seen in subacromial bursitis .The pain in this condition willdisappear on abduction of the arm.

- Dawsons sign-Palmar erythema in cirrhosis of liver

- De Dance sign-The Signe de Dance A feeling of emptiness in the right iliacfossa in acute intussusception.

- D Espines sign-A large mediastinal node or a mass in Bronchogenic carcinomamay transmit the tracheal sound .This can result in bronchial breath sound,whispering pectoriloquy and rarely egophony in the inter scapular region.(BelowD4)

- Delbets sign-in aneurysm of limbs main artery .

- Demusset sign-See Alfred Demusset sign

- Deuels halo sign- This is x-ray finding in intrauterine death. The usual zoneof reduced density visible around the head of relatively mature fetus beforedelivery appears to be separated from the cranium .The density of this zone willbe similar to that of the soft tissues. This can be demonstrated radiologicallywithin 3 days after the death of fetus.

- Dimple sign- Cart-Wheel pattern of fibroblast seen in Dermatofibrosarcomaprotuberans.

- Dimple sign(Fitzpatrick sign) in Dermatofibrosarcoma protuberans.

- Docks sign- Rib notching in corctation of aorta.

- Dogs ear sign-in ascites .Radiodensity superior and lateral to the bladder

- Double bubble sign-is seen in the following conditionsDuodenal atresia,Annular pancreas,Duodenal stenosis

- Double duct sign in ERCP- Carcinoma pancreas

- Drawer sign- see Anterior drawer sign-(Bon bruise sign)

- Dresslers sign-Dull note in the lower part of sternum in pericardialeffusion.

- Drooping lily sign- is seen in renal pelvis with duplicated collecting system.

- Dubois sign- Short little finger in congenital syphilis.

- Dugas sign-is seen in fresh shoulder dislocation . The patient will not beable to put the hand to the opposite shoulder with the elbow close to the body.

- Duroziezs sign- diastolic murmur heard on the femoral artery on distalcompression.(E)

- Emptying sign in straw berry angioma

- Erbs sign-seen in latent tetany. Muscular contractions can be produced byapplication of subthreshold electrical stimulation.

- Eye-of-the tiger appearance- is a MRI finding in Hallevorden-Spatz disease

- Ewarts sign- (Pins sign) Is seen in compression collapse of the basalsegments due to large pericardial effusion.. There will be dullness onpercussion, increased vocal resonance, tubular breath sounds., increased vocalresonance. and bronchial breathing are seen in cardiac tamponade due to pericardial effusion.

- Ewing sign- pericardial sign(F)

- Fagets sign- is seen in yellow fever. Relative bradycardia is present fromthe second day of the illness.

- Falling fragment sign-Solitary bone cyst.

- Fat pad sign-is seen in pericardial effusion .In normal persons the parietalpericardium is separated from the epicardial fat by about 1-2 mm. This isincreased in pericardial effusion.

- Felson s silhouette sign- any intrathoracic mass touching the heart ,aorta ordiaphragm will obliterate that border on the chest X ray.

- Fistula sign- Pressure changes can be transmitted to the membranouslabyrinth if there is a fistula in the bony labyrinth. Pressing the tragus willinduce jerk nystagmus.

- Fitzpatrick sign-in dermatofibroma .There will be dimpling when the mass issqueezed on both sides.

- Flag sign- Flag sign may be seen in Kwashiorkor. The hair will be alternatelynormal and depigmented. The hair in cases of severe malnutrition will behypopigmented. As the nutrition improves the pigmentation of the hair will benormal. Hence the hair will be alternately normally pigmented and hypopigmented,giving the appearance of a flag

- Flank stripe sign- or McCort sign-in ascites. Increased distance (>2 cm)between the properitoneal fat stripe and the right colon.

- Floating membrane sign- Hydatid cyst

- Floating teeth sign- in eosinophilic Granuloma.

- Flying W sign- the posterior mitral leaflet movement resembles the letter W.In partial systolic closure of the pulmonary valves there will be flying W sign.

- Football sign-In NNEC, the free air over the liver with outlining of thefalciform ligament indicates perforation and needs surgicaltreatment.(Pneumoperitoneum)

- Forscheimer sign- Enanthem in rubella.

- Foresters sign-In hypotonic or Atonic cerebral palsy, when the child islifted by holding at the axilla ,there will be flexion at the hips.

- Fredericks sign-Increased jugular venous pulse with sharp diastolic collapse.rapid Ydescent in pericardial effusion.

- Froments sign-in ulnar nerve paresis , Ask the patient to grasp a book firmly between the thumb and the other fingers .In normal persons the thumb willbe straight while holding the book . In patients with ulnar nerve palsy theterminal phalanx of the thumb will be flexed.

- Frostbergs inverted 3 sign-Carcinoma head of pancreas.(G )

- Galeazzi sign- is a check for apparent thigh length on both sides. There willbe lowering of the knee on the affected side when the child lies prone with hipflexed and knee flexed..

- Gerhardt's sign - Pulsations over the spleen in aortic regurgitation.

- Goodells sign Softening of cervix and vagina is a sign of pregnancy.

- Gonda sign Extensor response is elicited after forceful stretching orsnapping of distal phalanx of either of the 2nd or 4th toe.

- Gowers sign- is seen in Duchenne muscular dystrophy ,.It will be evident by 3years of age and will be fully expressed by 5-6 years of age. Climbing upon hisown body while getting up from sitting posture.

- Grassets sign in hemiplegia .When a patient with hemiplegia walk on heels,there will be abnormal movements of the hands on the same side of hemiparesis.The arms will come slightly in front, with elbow bent and not taking part in comovements. There will be inability to keep the fingers stretched and together.

- Grey Turners sign-A bluish discoloration seen in the flanks in patients withacute hemorrhagic pancreatitis.

- Griesingers sign- is seen in lateral sinus thrombosis. The thrombus mayextend and result in indurated tender area over the upper part of the internaljugular vein and mastoid region.

- Groove sign- Lymphogranuloma venereum (LGV) The enlarged lymph nodes are seenboth above and below the inguinal ligament.(H)

-Halo sign.- Severe erythroblastosis with hydrops fetalis is demonstrable byextensive edema, which elevates fat layers beneath the skin to produce a halosign. The so-called Buddha position is also indicative of hydrops fetalis

- Halo sign in breast tumour - a narrow radiolucent ring surrounding a benignbreat lesion.

- Hammans crunch sign -crackling ,bubbling, crunching and churning soundsheard over the precordium in pneumomediastinum..It is better heard during thesystole in left lateral position in expiration.

- Head drop sign - The patient is asked to lie down. The shoulders are raisedoff the bed. Usually the head also will raise but in this case the head lagwill occur. Children with poliomyelitis are unable to lift the head or bring italong the trunk, and this is known as head lag.

- Head light sign- perinasal and periorbital pallor in atopic dermatitis

- Heel pad sign- Acromegaly

- Hellmen sign-in ascites. Radiolucent shadow between the lateral walls; ofliver and the abdominal wall.

- Hegar s sign-Softening of the isthmus or the lower segment of the uterus Thiscan be seen at 6 -12 weeks of gestation.

- Hertoghes sign- Loss of lateral third of eyebrow in atopic dermatitis- Hicks sign-is seen in pregnancy. There is light, painless irregular uterinecontractions which increase in frequency and intensity as the pregnancyadvances.

- Higoumenakis sign-Enlargement of the medial end of the clavicle which is alate feature of syphilis.

- Hill's sign-is seen in Aortic Regurgitation .The systolic pressure in thelower limb is more than that of the upper limb .Normally this pressuredifference will be less than 20 mm of Hg. The severity of the aorticregurgitation can be assessed by measuring this difference. - Mild Aortic Regurgitation - 20-40 mm of Hg. - Moderate Aortic Regurgitation - 40 -60 mm of Hg. - Severe Aortic Regurgitation - >60 mm of Hg.

- Hip sign - The lower limbs of a preterm baby can be abducted for more than 160degrees- Hoffmans sign is significant of pyramidal lesion. The terminal phalanx of

middle finger to be grasped by the examiner. The hand to be pronated. Sharpflickering movement of terminal phalanx will produce adduction and flexion ofthe thumb and flexion of the other fingers.

- Homans sign-is positive in venous thrombosis. Tenderness can be elicited indirectly by forcible dorsiflexion of the foot with the knee extended.

- Hook sign-In acute fulminating tenosynovitis there will be flexion of fingerwith pain on extension.

- Hoovers sign is seen in pleural effusion .There will be decreased chestmovements on the affected side in pleural effusion.

- Hoovers sign(for unilateral weakness or paralysis of one leg )- is done todifferentiate between paralysis and Pseudoparalysis of one leg .The examinershand is placed under the heel of the paralysed leg .Now ask the patient to raisethe normal leg against resistance .In normal individuals the examiner can feelthe pressure by the normal leg ..This will be absent if the leg is weak orparalysed.

- Hutchinsons sign- In Herpes Zoster ophthalmicus, when the tip of the nose isinvolved ,the eye also will, be involved. This is because both the area aresupplied by nasociliary nerve.

- Hyppocratic sign- Succussion splash present in pyopneumothorax.( I )

- Inverted mustache sign- seen in x -ray chest in congestive cardiac failure.(J)

- Jacquemiers sign-(Chadwicks sign) bluish discoloration of the vagina willbe seen by about 4-8 weeks of pregnancy.

- Jellinek sign- Hyperpigmented lid in hyperthyroidism

- Joffroys sign-Absence of wrinkling on the forehead on looking upwards inthyrotoxocisis.(K)

- Kanavels sign- In infection of ulnar bursa ,there will be tenderness overthe part of the ulnar bursa lying in between the transverse palmar creases.

- Kehrs sign-pain referred to the left shoulder in rupture of spleen .The painis due to the contact of blood in the under surface of diaphragm .The pain ismediated through the afferent fibres of the Phrenic nerve.

- Kernigs sign-The patient lies supine .The hip is flexed and the knee isextended passively. In patients with meningitis there will be pain and spasm ofhamstrings.It is positive in meningeal irritation and sub arachnoid haemorrhage. It isrelatively less important in infancy and early childhood as it may be negativein spite of meningeal involvement. However, it is a very useful sign in olderchildren.

- Kestenbaums sign- is seen in optic atrophy. The number of capillaries thatcross the disc margin is reduced from a normal of 10 to 7 or less.

- Kiloh-Nevin sign-Ask the patient to form a O with the tip of the finger andthe index finger In patients with anterior interosseous syndrome, fine pinchposture is abnormal.

- Kiss the-knee sign- Ask the child to sit and kiss the knee. In the presenceof Nuchal rigidity, the child cannot kiss the knee without bending the knee.

- Kochers sign-Frightened, staring look in Thyrotoxicosis.

- Knuckle sign- is seen in vessel occlusion due to thrombosis .there is anabrupt tapering of the vessel distal to the occlusion.

- Kritchleys sign (Cortical thumb) in pyramidal tract lesion.

- Kussmauls sign- Inspiratory prominence of jugular veins in pericardialeffusion, constrictive pericarditis, restrictive cardiomyopathy..(L)

- Ladins sign-is seen in pregnancy. There is softening of the medial anteriorsurface of the body of uterus just above the body and cervix.

- Lambda sign- Small ascending aorta seen in hypoplastic left heart syndrome

- Laminar dot sign- -seen in advanced glaucoma.

- Landolfi's sign - constriction and dilatation of pupils with the heart beatsand not related to light reflex.

- Lassigue sign-A positive leg rising test .It is present in sciatica, prolapsedintervertebral disc. With the patient lying supine, ask him to elevate theextended leg .A normal person can extend up to 90 degrees. The test is positiveif the movement is restricted.

- Lemon sign- See banana sign the frontal lobes will be concave .This is due toneural tube defects.

- Leris sign- is seen in hemiplegia. There will be absence of normal flexion ofthe elbow on passive flexion of the hand at wrist on the affected side.

- Leser-Trelat sign- is seen in internal malignancy. There will be suddenappearance of large number of keratosis.

- Lhermittes sign- electric shock like sensation radiates down the trunk ,whenthe trunk is flexed .it indicates cervical cord lesion ,cervical spondyloticmyelopathy, sub acute combined degeneration of the cord, radiation myelopathy

- Light house sign - alternate flushing, and blanching of the forehead in AorticRegurgitation

- Light house sign in acute Suppurative otitis media.. a pulsating dischargewill reflect the light intermittently.

- Littens sign- in diaphragmatic palsy .There is absence of indrawing ofsubcostal margin during inspiration.

- Ludloffs sign is seen in avulsion fracture of the lesser trochanter. Therewill be inability to flex the stretched leg, when the patient is seated.(M)

- Macewens sign (Crack pot resonance) - a cracked-pot sound on percussionof the skull, may be present with hydrocephalus, increased intracranial pressureand sutural separation. It is due to separation of sutures in a child havingincreased intracranial tension. It is also simulated in many normal infants. Toelicit this sign the childs head should be lifted up from the bed and supportedby putting the examiners hand under the neck In children who can sit up thiscan be done in the sitting position. A sharp tap with the middle finger isgiven on the parietal region on each side.

- Macewens sign (in pericardial effusion )

- Macewens sign (alcohol poisoning ) pupillary sign.

- Marcus Gunn pupil sign- is seen in the patients with asymmetric,prechiasmatic, afferent conduction defect.

- Marions sign-seen in benign prostatic enlargement.

- Mathes sign-In patients with perinephric abscess, the kidney does not descenddown in erect posture .In normal persons the kidney will descend in erectposture .

- Maxwell-Lyons sign-is seen in vernal conjunctivitis. A fibrinouspseudomembrane may be seen.

- Mc Burneys sign-In acute appendicitis; pain can be elicited at the Mcburneyspoint by pressing with a finger

- McEwan sign- In coma the pupil is constricted and dilates on painful stimuli.

- McMurrays sign-In meniscus injury a painful click can be demonstrated if theflexed tibia is rotated upon the femur.

- Melting sign- In pulmonary embolism with infarction .The consolidationregresses from periphery to the centre.

- Mercedes Benz sign (Seagull sign) When gas is present in the gall stones, acharacteristic dark shape will be seen in the X ray

- Milians ear sign- Erysipelas can spread in to the pinna (cellulitis cannotspread as there is no areolar tissue )

- Milk maid sign-Ask the patient to hold the examiner's hand,(index and middlefingers can be placed together).Feel for the uniformity in the force ofcontraction by the patient. Ask the patient to hold the fingers of opposite handand compare with the other side. In the affected side there will be alternatingforces (contractions and relaxations),as like milking of a cow.

- Meniscus sign- seen in X-ray , when a mobile mass is present in thepulmonary cavity due to aspergillus fungal ball

- Moebius sign Lack of convergence of the eye ball in thyrotoxocisis.

- Moniz sign Extensor response is seen after forceful passive plantar flexionof ankle

- Moses sign-In venous thrombosis, pain can be elicited by squeezing the calfmuscles.

- Moulage sign-is seen in Malabsorption syndrome .It is due to flocculation andsegmentation of barium and mucosal thickening.

- Moynihams sign- is acute cholecystitis.

- Muller's sign - Pulsations seen in the uvula, in aortic regurgitation.

- Munsons sign- is seen in keratoconus. There will be bulging of the lower eyelid when the patient looks down.

- Murphys Sign: Ask the patient to breathe in deeply and palpate for gallbladder. At the height of inspiration the breath is arrested with a gasp as themass is felt. This is the sign of acute cholecystitis.(N)

- Naffzigers sign-Stand behind the patient and look vertically downwards in theplane of super ciliary ridges .The eye balls can be seen protruding out of thisplane if proptosis is present.

- Napkin ring sign-Annular carcinoma of colon.

- Nashes sign- Increased pulmonary blood flow in moderate and severe VSD.

- Naunyns sign-See Murphys sign

- Nicoladonis sign- see -Branhams sign

- Nicolskys sign-Separation of the epidermis on giving pressure over the skin.Pemphigus vulgaris, TEN Toxic Epidermal necrolysis, porphyria, StevensonJohnsons syndrome, Staphylococcal scalded syndrome.(O)

- Oil drop sign- In psoriasis .there is discolouration of nail bed.

- Ollendorf sign- is seen in secondary syphilis. The papule is tender .

- Ollivers sign-Upward and down ward movement of the trachea can be seen inpatients with COPD. The chin should be raised and upward pressure should beapplied over the trachea. A downward traction can be felt on the trachea. Thisis known as tracheal tug.

- Oppenheims sign Heavy pressure is applied by the thumb and index fingerfrom above downwards over the anterior surface of tibia (to its medial side). The extensor response usually occurs towards the end of the stimulation.

- Ortolanis sign-Ortalanis sign of jerk is the earliest sign of congenitaldislocation of hip. By holding the limbs with the hip and knees flexed ,abductthe hip joint.Placea finger over the greater trochanter.A click can be felt asthe femoral head slips in to the acetabulum.

- Osianders sign will be seen in pregnancy due to -increased vaginal pulsations

- Oslers sign- Alkaptonuria(P )

- Panda sign- bilateral periorbital haematoma in a patient with a fracture ofthe anterior cranial fossa.

- Pardees sign- It is an electrocardiogram finding in myocardial infarction. Afew hours after the infarction there will be a Q wave and S-T segment iselevated.

- Pastias sign-is seen in scarlet fever .Residual petechial lesions in theantecubital fossa.

- Peroneal sign-Seen in latent tetany. Tapping the peroneal nerve at the neck ofthe fibula will produce dorsiflexion and abduction of the foot.(eversion offoot )

- Patellar apprehension sign-apply lateral pressure to the patella with the kneeextended to 30 degrees .and the quadriceps relaxed .The patient fears that thepatella may be dislocated and extends the knee thereby relocating the patellato the normal position.

- Patellar tap sign- is seen in knee joint effusion. The effusion delays thepatellar tapping against the femur. ,when it is pressed firmly and quickly.

- Pedestal sign- is seen in cementless total hip arthroplasty, when there isprosthetic loosening of the femoral stem

- Pelkens sign- is seen in scurvy. Thickened zone of provisional calcification protruding beyond the border of the shaft.

- Pen Britton sign-In retrosternal thyroid, on lifting the upper limbs ,theface is suffused, due to the pressure by the thyroid on the SVC

- Penetrating sign-A radiological finding in benign gastric ulcer. The ulcercrater should project from the contrast filled lumen and erode in to the stomachwall rather than in to the mass in the stomach wall.

- Phalens sign-In carpel tunnel syndrome ,the signs and symptoms will increaseon flexion of the wrist .On straightening these will improve. This is also knownas Wrist flexion test..

- Phelps sign is seen in Glomus jugulare.

- Pipe stem sign- is seen in Ulcerative colitis.

- Pillow sign- hairs on the pillow on getting up in nethertons syndrome.

- Platysma sign of Babinski- Loss of contraction on eversion of lower eyelid orretraction of angles of mouth..

- Prayer sign-Is seen in diabetes. It is due to limited joint mobility(Cheiroarthropathy) There is inability to extend, the interphalangeal joint to180 degree or limited joint mobility of interphalangeal joints of at least onefinger bilaterally.

- Prehns sign- is seen in epididymo -orchitis .On elevation of the testis thepain increases in torsion and in epididymo-orchitis the pain decreases.

- Pronator sign-Ask the child to hold the hands above the head with the palmfacing each other for some time. The patient will not be able to hold it insame position. The hand on the affected side will be pronated and the palm willface outwards

- Pseudo-babinski's sign The plantar extensor response may be seen in the absence ofpyramidal tract lesions in the following conditions 1) Voluntary withdrawal 2) In plantar hyperaesthesia 3) Strong or painful stimulus, 4) In extrapyramidal lesions

- Pseudo Darrier sign- Congenital smooth muscle hamartoma

- Puddles sign -To diagnose minimal ascites. The patient is put in knee chestposition .Percuss the abdomen towards the umbilicus to elicit the dullness.

(Q )

- Quinke's sign (In aortic regurgitation) There will be alternate flushing andblanching in the nail bed. (R)

- Raccoon eye sign-is seen in fracture of the base of the skull. Bilateralecchymosis and swelling of the upper eye lids will be present..

- Red dot sign-Abdominal wall is discolored with focal or diffuse erythemareflects underlying peritonitis. This sign is seen in neonatal necrotizingenterocolitis.

- Reissers sign-iliac apophysis fuses with the iliac bone at maturity .Thisindicates a completion of growth. There will be no worsening of Scoliosis.

- Reversed 3 sign in barium x ray- Coarctation of aorta.

- Rib notching sign is seen in coarctation of aorta.

- Rigler sign- The bowel wall will be outlined by air inside and outside, inPneumoperitoneum.

- Rim sign-In severe hydronephrosis some times only a thin rim of the contrastwill be seen outlining the kidney. This is due to the contrast mediumcirculating in the capillaries compressed by the dilated calyces.

- Roberts sign- appearance of gas shadow in the heart and great vessels by 12hours of fetal death

- Romanas sign- in Chagas disease ,.there will be unilateral painless oedemaof the periorbital tissues .it is due to infection through the conjunctiva.

- Rombergs sign-It is a test to find out the loss of position sense. It isspecial test to find out the Co-ordination of the lower limbs. The patient isasked to stand with his feet close together with both his eyes opened andclosed. If Rombergs sign is present as soon as the patient closes his eye, hebegins to sway or may even fall, It signifies sensory ataxia.

- Rope sign- due to constriction of hypopharynx in poliomyelitis. There is acuteangulation between the chin and larynx due to weakness of the Hyoid muscles.

- Rosenbachs sign - Pulsations of the liver in aortic regurgitation.

- Rossolimos Sign- Plantar surface of the Great toe is tapped with a hammer orflick the distal phalanges of the toes into extension and then allow them tofall back to their normal position. In pyramidal tract lesions, there will beplantar flexion of all the other toes including the Great toe. (This isequivalent of Hoffmans sign of the upper limbs)

- Rotchs sign- Flat note in the cardio hepatic angle on the right side inpericardial effusion .

- Rovsings sign-In appendicitis, when the abdomen is pressed on the left iliacregion ,there will be pain in the right side. This is due to the stretching ofthe inflamed peritoneum on the right side.(S)

- Sail sign- The sail shaped shadow of the thymus in the upper mediastinalshadow.

- Sandwich sign- Mesenteric adenopathy.

- Schamroths sign .This is seen in clubbing .Normally when the thumbs areplaced in close approximation to each other so that the nails are facing eachother a quadrangular space can be seen in between the thumbs. In clubbing(Grade II or more) of the fingers this space will be obliterated. This is calledShamroth sign.

- Scarf sign- The elbow crosses the midline when the arm is crossed across thechest .Keep the head in the midline pull the hand across the chest .The elbowwill cross the midline in preterm babies..

- Schwartz sign- is seen in Otosclerosis. A pink tinge may be seen due tootospongiotic mass (Flamingos tint)

- Scimitar sign- Crescentic shadow (Curved Turkish sword shaped shadow) ofvascular density along the right border of the cardiac silhouette. This is dueto anomalous pulmonary vein draining in to the inferior vena cava.

- Scottish dog sign- is seen in spondylolysis. The defect is in the parsinterarticularis.. It appears like a scottish dog wearing a collar .

- Sea gull sign- See Mercedes Benz sign

- Sectoral sign- is seen in Avascular necrosis of femoral head. The internalrotation of the hip will be full with hip extended ,but will be grosslyrestricted with the hip flexed.

- Seidels sign- Sickle shaped extension of the blind spot above or below ,orboth ,with the concavity of the sickle directed towards the fixation point.This sign is seen in field defects ,in simple glaucoma

- Setting sun eye sign - Usually seen in hydrocephalus . - Normally the scleraabove the upper limbus will not be visible. In hydrocephalus , eyes deviatedownward because of the impingement of the dilated suprarenal recess on thetectum. .In normal new born babies this may be visible transiently. Inkernicterus and hydrocephalus it will be persistent

- Shawl sign- In dermatomyosistis .there will be erythema over the upper backand shoulders.

- Shoulder sign-The hypertrophied pyloric muscle will cause an indentation ofthe barium filled antrum in patients with Hypertrophic pyloric stenosis.

- Shrug sign is seen in patello-femoral osteoarthritis.There will be pain ,whenthe patella is compressed manually against the femur during quadricepscontraction.

- Sore thumb sign-Acute Epiglottitis .

- Signet ring sign-seen in the x-ray of a patient with scurvy.

- Silk sign- on physical examination , thickening of the spermatic cord inchildren with inguinal hernia. .It is elicited by palpating the spermatic cor dat the pubic tubercle.

- Soft neurological signs is a particular form of deviant performance on amotor or sensory test in a neurological examination that is abnormal for aparticular age. These are present in normal children at some stage of theirdevelopment like .repetitive and successive finger movements, foot taps,hopping, tandem walking.

- Spaldings sign- This is a radiological feature of intrauterine deathoverlapping of the skull bones at the sutural lines and shrinkage of the skullcontents in fetal death.

- Spatula sign- In tetanus, spasm of the child will be aggravated, when thechilds mouth is pressed with a spatula.

- Spooning sign is seen in chorea. Ask the patient to stretch the arms forwardand hold them parallel to the floor with the palms facing each other. Theaffected arm will be flexed at the wrist and extended at the metacarpophalangealjoints.This resembles a dinner fork.( Dinner fork deformity)

- Steeple sign in croup.

- Steinberg sign- ( Thumb sign) -In Marfans syndrome ,Protrusion of the thumbbeyond the ulnar border of the hand ,when flexed across the palm..

- Step sign seen in - Spondylolisthesis, - Acromio clavicular dislocation.

- String of beads sign-in dilated small bowel filled with fluid, small bubblesof gas may be trapped between the valvular conniventes

- Square root sign- on right ventricular pressure tracing in constrictivepericarditis.

- Stellwag sign-(Staring look ) Infrequent blinking in Thyrotoxicosis.

- String sign-is seen in Hypertrophic pyloric stenosis. In barium meal study theelongated pyloric canal will be seen as a single line of barium. Some times itwill be seen as a double line.

- String sign of Kantor- in barium meal study.-Crohns disease is due to themarked narrowing of the affected bowel.

- Sulcus sign a radiological sign in inferior dislocation of shoulder ,wherethe head of the humerus lies below the glenoid.

- Sun setting sign-See setting sun eye sign.

- Suzman's sign-In Coarctation of aorta collaterals are formed in the back andwill cause pulsations over the back.. The pulsations are prominent over thescapula and is best visualized with the patient bending forwards.(T )

- Target sign Thick pylorus in the ultrasonogram in pyloric stenosis

- Tear drop sign- in orbits- Blow out fracture

- Tear drop sign- in ankle-Ankle effusion

- Tent sign- In ovarian cyst ,the vaginal fornix on that side will be deep likea tent.

- Terry Thomas sign- Scapholunate dislocation

- Thinkers sign- due to the abnormal posture of the patient in COPD.

- Thumb sign-See Steinberg sign. It is seen in Marfans syndrome.

- Thurston-Holland sign -Intra articular fracture ,the line going through theplate and through the part of the metaphysis.

- Tinels sign-When a regenerating nerve is tapped at the level of regenerationthere will be a tingling sensation

- Tragers signThis is a sign of fetal death in utero. The fetal attitude in a X-ray will bewith marked curvature or collapse of spine. Loss of fetal attitude or posture isa result of decreased muscle tone .

- Trail sign- Undue prominence of clavicular head of sternomastoid muscle onone side is indicative of tracheal displacement to that side .

- Tram track sign-Double track of barium will be seen outlining the Hypertrophicmucosa in the elongated pyloric canal in Hypertrophic pyloric stenosis.

- Tram track sign-is also seen in Sturge Weber syndrome.

- Tram track sign-is also seen in membranous glomerulonephritis.

- Traube's sign - Pistol shot sound in the femoral artery in aorticregurgitation

- Trendelenburg sign-in congenital dislocation of hip. Ask the patient to standon one leg and note the position of the pelvis. If the test is negative thepelvis will be raised on the unsupported side .If the test is positive thepelvis will drop on the unsupported side.

- Trethowans sign- is positive in slipped femoral epiphysis. Normally the linedrawn along the superior surface of the neck passes bisecting the head of femur.In this condition this line` passes superior to the head.

- Triple bubble sign- Jejunal atresia.

- Tripod sign is seen in poliomyelitis. The child sits with the knees flexed andboth the hands placed behind him supporting on the back as if in the tripodposition. On stretching the legs the meninges are stretched which aggravatesthe pain. By assuming the tripod position the stretching of the meninges isavoided thereby the pain is reduced.

- Troisiers sign enlarged left supraclavicular node (Virchows node)due thegastric malignancy.

- Trolley track sign -Signs in Ankylosing spondylitis Three vertical linerarlines with increased density will be seen.

- Trousseaus sign-Phlebo thrombosis of superficial veins.

- Trousseau's sign-Ischemia of the upper limb is caused by inflating asphygmomanometer cuff above the arterial pressure for not more than 2-3 minutes.. This will precipitate the carpopedal spasm.

-Trumbling bullet sign is seen in post-traumatic bone cyst.

- Trumpet sign- is seen in intervertebral disc herniation. Enlargement of thenerve root seconday to edema.

- Throgmortons sign-Extension of the suspensory ligament of the penis prior tomicturition in newborn infants.( V )

- Vacuum cleft sign- is seen in vertebra plana.

- Vallecular sign-Retention of barium in hypopharynx in patients with carcinomaof larynx.

- Vascular sign of Narath- is seen in anterior dislocation of the hip joint. Thefemorals are easily felt in Scarpas triangle.

- Verumonten sign- is seen in complete rupture of urethra. The prostate will befloating in per rectal examination.

- Von Graefes sign- in Thyrotoxicosis. Lag of the upper lid on downward gaze.

- Von Rosens sign (Barlows sign ) In congenital instability of the hip jointthe hips are held flexed and abducted , A click can be heard when the femoralhead leaves the acetabulum .

- Victor Horsleys sign-The temperature will be 1-2 degree more on theparalysed side.( W )

- Water Lily sign- Hydatid cyst.

- Watenberg 's sign.-The fingers of the hand to be examined should be flexed andinterlocked to the examiners flexed fingers. A pull in the opposite directionshould be applied , so that the fingers of each other pull against other'sresistance. Normally the thumb extends. In the presence of cortical lesions thethumb adducts and flexes.

- Wimbergers signX-ray knee bilateral erosion in upper medial end of tibia. Itwill be seen in congenital syphilis ,scurvy .

- Winter bottom sign- is seen in Trypanosoma brucei infection Africantrypanosomiasis (Sleeping sickness).The regional nodes enlarge in the posteriorcervical triangle..

- Wredens sign- is seen in a stillborn baby. Gelatinous material more or lesscompletely fills the external auditory meatus.

- Wrist sign-It is seen in Marfans syndrome. Ask the patient to grasp the wristwith the thumb and the little finger. There will be overlapping of the fingers.

- W sitting- is seen in persistent anteversion of the femoral neck .Childrensit between their feet with the hips fully internally rotated.OTHER SIGNS-- 3 sign on paramediastinal shadow in x ray-i n Coarctation of aorta.- Sign of ridge-seen in dehydration- Thumb sign- Acute Epiglottitis- V sign of Naclerio- Pneumomediastinum + Pneumothorax (Boorhaeves syndrome)- Deep lateral femoral notch sign- Tibia vara due to retarded growth of medialhalf of the proximal tibial epiphysis (Blounts disease)- Vital signs- pulse, respiration, temperature.RADIOLOGICAL SIGNSCoffee bean sign (Birds beak deformity or ace of spade deformity is seen insigmoid volvulus.

Double stomach appearance Atresia and stenosis of duodenum.

Double bubble sign- Duodenal atresia.

Meniscus sign in chest X ray- aspergillus fungal ball.

Mercedes Benz sign (Sea gull sign) radiolucent gall stone with gas in it

Triple bubble sign- Jejunal atresia

Floating membrane sign-Hydatid cystSIGNS ASSOCIATED WITH VARIOUS CLINICAL CONDITIONS-(A)1) Signs in Ankylosing spondylitis Dagger sign Trolley track sign Bamboo spine appearance Squaring of vertebra Anderson fracture (disco vertebral fracture)2) AORTIC REGURGITATION -PERIPHERAL SIGNSThe volume output from the left ventricle is high and also there is a diastolicrun off. This causes a rapid filling of the peripheral blood vessels and rapidemptying of these vessels. This is the cause for the peripheral signs of theaortic regurgitation.a) Demusset signb) Light house sign - alternate flushing, and blanching of the forehead.c) Becker's sign - Pulsations seen in the retinal artery.d) Landolfi's sign - constriction and dilatation of pupils with the heart beatsand not related to light reflex.e) Muller's sign - Pulsations seen in the uvula.f) Corrigan's sign - Dancing carotids.g) Locomotor brachi -The pulsations in the brachial artery is seen prominentlyin the medial aspect of the arm, with the arm in a semi flexed position.h) Water hammer pulse-(Collapsing pulse)i) Quinke's sign -There will be alternate flushing and blanching in the nailbed. j) Hill's sign-k) Rosen Bachs sign - Pulsations of the liver.l) Gerhardt's sign - Pulsations over the spleen.m) Traube's sign - Pistol shot sound in the femoral artery.n) Duroziez murmur - a diastolic murmur is heard over the femoral artery withthe diaphragm of the stethoscope when the femoral artery is compressed distally.(4 Ds Duroziez's murmur. Diastolic murmur, Diaphragm, Distal compression.)

3) Signs in appendicitis a) Aarons sign b) Bastedos sign c) Rovsing s sign d) Dieulafoys triad- e) Blumbergs sign f) Coopers sign- In acute appendicitis , the tenderness iselicited in the left lateral position.4) SIGNS OF ASCITES Flank stripe sign- or McCort sign- Increased distance (>2 cm)between the properitoneal fat stripe and the right colon. Hellmen sign- Radiolucent shadow between the lateral wall of liverand the abdominal wall. Dogs ear sign-Radiodensity superior and lateral to the bladder

5) Signs in ASOM-

- Light house sign - Nipple sign

6) Signs in ATRIAL SEPTAL DEFECT -- Jug-handle appearance in ASD , (dilated right atrium, ventricle, andpulmonary arteries with less prominent aortic knuckle)- Hilar dance On fluoroscopy there is conspicuous pulsation of the pulmonaryarteries.(C )

1) SIGNS IN CARDIAC FAILURE- Features of left ventricular failure Cardinal signs of left ventricular failure are a) Gallop rhythm-S3 will be heard along with S1 and S2 .This iscalled triple rhythm. This will be associated with tachycardia in gallop rhythm. b) Pulsus alternans c) Fine crepitations at the base of the lungs. Features of right ventricular failure Cardinal signs of right ventricular failure are a) Elevated jugular venous pulsations b) Hepatomegaly-soft, tender, may be pulsatile c) Oedema of dependant parts.-Pedal oedema in patients who arestanding and sacral oedema in recumbent patients.

2) CARDIOMYOPATHYSigns of restrictive cardiomyopathy are Edema, Ascites, Enlarged pulsatile liver Increased JVP Kussumauls sign Third and fourth heart sounds. Hepatojugular reflex will be present.

3) CEREBELLAR SIGNSa) Ataxia (In co-ordination of movements)Truncal ataxia -difficulty in sitting, standing etc(occurs in vermis lesion) b) Titubation c) Dyssynergia- Past pointing d) Intention tremor e) Dysmetria f) Dysdiadochokinesia g) Rebound phenomenon h) Ataxic gait i) Speech Dysarthria. j) Nystagmus k) Pendular knee jerk

l) Hypotonia Tandem walking-(Heel-toe )The patient is asked to walk in a straightline with the heel of the foot placed near the tip of the toes of the other leg.This will be abnormal in patients with cerebellar lesions and posterior columnlesions. Romberg test. The patient is asked to stand straight with both thefeet close to each other .First the patient is asked to stand with the eyes openand then with the eyes closed. In cases with posterior column lesions where theposition sensation is lost, the patient will fall on the side of the lesion whenthe eyes are closed. This is because the patient adapts to the loss of positionsensation by the visual assessment of the positions. When the eyes are closed orin the dark this adaptation will be lost and the patient tends to fall down

4) SIGNS IN ACUTE CHOLECYSTITIS Cystic duct sign Rim sign

5) SIGNS IN CHOREA-Chorea-are semi-purposive ,brief ,jerky, irregular a) Hypotonia. b) Jack in box tongue- Involuntary protrusion and retraction of thetongue. c) Pronator sign d) Milk maid sign-(Milking sign) e) Hung up reflex- With the patient sitting on the bed with the legshanging freely the knee jerk is elicited. The extension at the knee joint willbe maintained for some time before the leg comes down. This is called hung upreflex and occurs in the affected side. f) Spooning sign- g) Emotional lability h) Czernys sign

6) SIGNS IN CIRRHOSIS LIVER - Dawsons sign - Terry nails (leuconychia ) white nails seen in thumb and indexfingers .- Dupuytrens contracture- Clubbing- Spider angiomata

7) SIGNS IN COARCTATION OF AORTA- - Docks sign - Suzmans sign

8) SIGNS OF VERNAL CONJUNCTIVITIS. - Maxwell-Lyons sign-- White ropy discharge- Cobble stone appearance- Trantas spots at the limbus.

9)CORTICAL SIGNS Astearognosis, Apraxia, Alexia, Acalculia Blindness (Cortical) Cortical Thumb, Clonus, Discrimination (Two-Point), Dysarthria Extensor (Plantar Reflex) Fundal Changes Growth Retardation(-In Infantile Hemiplegia),Glabellar Reflex Hypertonia, Intelligence decreased Jerks -Exaggerated, Judgement impaired Mentation, Memory affected Neonatal Reflexes Orofacial Apraxia, Orientation- Affected. Palmomental Reflex, Perseveration Snout Reflex, Sucking ReflexCORTICAL SYMPTOMS Aphasia Bladder disturbances Convulsions(D)

1) SIGNS OF SEVERE DEHYDRATION-- Depressed fontanella - Dry tongue,- Sunken eyes,- Skin turgor- decreased- Sign of ridge-when the skin is pinched and released the ridge formed willdisappear very slowly.,

2) SIGNS OF DISLOCATION Sulcus sign a radiological sign in inferior dislocation of shoulder,where the head of the humerus lies below the glenoid.(E)1) SUB ACUTE BACTERIAL ENDOCARDITISAnemia Clubbing- -acute, Tender Oslers nodes- Painful, Pea sized intradermal nodes In the Pads of fingers and toes Janeway lesions-painless, small erythematous, hemorrhagic lesionsin palms and soles Splinter hemorrhages-beneath the nails PetechiaeTender splenomegaly Microscopic hematuriaRoth spots(F)

1) False localizing signs- Increased intracranial tension will result in lateral rectus palsydue to the stretching of the abducent nerve.

2) Signs of Avascular necrosis of femoral head a) Positive Trendelenberg s sign b) Sectoral sign

3) Signs of fetal death-- Roberts sign- Spalding sign- Balls sign- Duels or halos sign - Trager sign

4) Signs of fracturea) Crepitusb) Deformityc) Local bony tendernessd) Abnormal mobilitye) Shortening of a segment of limb 5) Basilar skull fractureFour classical signs of basilar skull fracture a) Racoon eyes- Periorbital ecchymosis in anterior basilar fracture. b) Battles sign c) Hemotympanum (Fracture of the petrous ridge ) d) CSF otorrhoea /Rhinorrhea. (Fracture cribrifirm plate )(G)SIGNS IN GASTRIC ULCER- a) Carmans sign- is seen in malignant gastric ulcer. Meniscusshaped gastric ulcer with the concavity pointed towards the gastric lumen b) Penetrating sign-The ulcer crater should project from thecontrast filled lumen and erode in to the stomach wall rather than in to themass in the stomach wall.

(H )1) Signs of congenital dysplasia of hip joint - Allis sign- Galeazzi sign-- Trendelenburgs sign.

2) Signs of hydronephrosis- Rim sign

3) SIGNS IN HYPERTROPHIC PYLORIC STENOSIS. a) Target signb) Tram track sign-c) String signd) Beak signe) Shoulder sign

4) SIGNS OF HYPOPARATHYROIDISM-a) Trousseau's sign-b) Chvosteks sign5) EARLY SIGNS OF HYPOTHYROIDISM-Prolonged physiological jaundice,Hypothermia,Hypotonia,Mottled skin,(I )

1) INTUSSUSCEPTION - Signs of intussusception area) Claw signb) Pitch fork sign in barium enemac) oiled spring deformity(K)

1) EARLY SIGNS OF KERNICTERUS- Poor feeding Lethargy Altered cry Altered behaviour

2) SIGNS OF KNEE JOINT EFFUSION a) Patellar tap sign- b) Bulge sign(L )1) Lateralizing signsIn coma it will be difficult to recognize the focal neurological signs .Thefollowing features wil indicate the side of the lesiona) Menace reflex (Asymmetric hemianopia)b) Facial weaknessc) Abnormal toned) Response to painful stimulie) Asymmetry in plantar responsef) Asymmetry in tendon reflexesg) Asymmetry in decerebrate and decorticate positioning.2) SIGNS IN LIVER FAILURE- - Alopecia-Hair loss (loss of pubic and axillary hair) - Parotid swelling - Jaundice - Abdominal distention - Ecchymoses- Paper money skin., spider nevi, - White brittle nails - Pruritis - Foetor Hepaticus- Palmar erythema,- Duputryens contracture- Gynaecomastia - Caput medusa - Gastrointestinal bleeds- Haematemesis - Ascites - Oedema- Testicular atrophy- Neurological signs- Asterixis(M )

1) SIGNS IN MARFANS SYNDROME a) Arachnodactyly-long and slender fingers and toes .b) Steinbergs sign or thumb sign -The thumb may be adducted across the narrowpalm.c) Wrist sign-(N )

1) SIGNS OF NERVE PARESISUlnar nerve paresisa) Froments signb) Paper test for interosseous musclesc) Claw hand

Median nerve- paresis . Median nerve is paralysed in Carpel tunnel syndrome a) Pointing index-Ask the patient to close the fist .Theindex finger will be pointing. b) Simian or Ape like hand (Ape thumb deformity)Thethumb lies in the plane of the hand due to paralysis of the opponens and theshort flexor muscles. c) Inability ot flex the interphalangeal joints due toparalysis of flexor Pollicis Longus.

Radial nerve- paresis a) Saturday night palsy b) Wrist drop. c) Finger drop, thumb drop.

Winging of scapula- Paralysis of serratus anterior (Nerve of Bell-Nerve toserratus anterior)

2) SIGNS OF NECK RIGIDITY a) Kernig's sign b) Brudzinski sign Neck sign Leg sign c) Lassigue sign d) Lhermitte 's sign e) Tripod sign-in poliomyelitis

3) NECROTIZING ENTEROCOLITIS Pneumatosis intestinalis Foot ball sign- if Pneumoperitoneum is present.(O)1) OPTIC ATROPHYSigns of Optic atrophy Uthoffs phenomenon- Worsening of vision during fever in hot weatheror after exercise .central conduction is slowed by increase in the bodytemperature(P )

1)PANCREAS SIGNS IN ACUTE HEMORRHAGIC PANCREATITIS.a) Cullen signb) Grey turner sign CARCINOMA HEAD OF PANCREAS a) Frostbergs inverted 3 sign b) Rose thorning of duodenum c) Scrambled egg appearance d) Double duct sign

2) SIGNS IN PERICARDIAL EFFUSION- Dresslers sign- Rotchs sign-Dullness over the right sternal border.- Friedreichs sign-Rapid y descent- Kussmauls sign- Pulsus paradoxus- Ewarts sign- Gerhards dullness- Dullness over the second left intercostal space.- Ewing sign

3) SIGNS IN PLEURAL EFFUSION- Ewarts sign

4) Signs of PNEUMOPERITONIUM - Football sign - Rigler sign - Telltale triangle

5) SIGNS IN POLIOMYELITIS - Tripod sign - Rope sign-- Head drop sign- - Kiss the-knee sign- Ask the child to sit and kiss the knee. Inthe presence of Nuchal rigidity ,the child cannot kiss the knee without bendingthe knee. - Phantom hernia-Bulge seen in the abdominal wall due weakness ofabdominal muscles.6) SIGNS IN PREGNANCY a) Hegars sign softening of cervix in pregnancy b) Osianders sign (Vaginal sign) increased pulsations throughlateral fornices .this occurs by 8 weeks of gestation. c) Goodells sign (Cervical sign) Softening of the cervix withbluish discoloration by 6 weeks of gestation d) Jacquemiers sign (Ghadwicks sign) dusky hue of the vestibuleand the anterior vaginal wall occurs by 8 weeks of gestation e) Placental sign- Cyclical bleeding occurs up to 12 weeks ofpregnancy. f) Braxton Hicks sign- g) Ladins sign7) SIGNS IN A PRETERM-a) Scarf sign The elbow crosses the midline when the arm is crossed across thechest.b) Hip sign - The lower limb can be abducted for more than 160 degrees(S )

1) THE SIGNS OF RECENT SCARLET FEVER a) Desquamation of palms and soles b) Pastias sign-

2) Signs in scoliosis Reisser s sign-iliac apophysis fuses with the iliac bone atmaturity .This indicates a completion of growth.

3) SIGNS IN SPONDYLOLISTHESIS- Beheaded scottish terrior sign- Scotty dog with collar sign Incomplete ring sign Inverted Napoleon hat sign is seen in Spondylolisthesis- of the L5vertebral body.4) SYPHILISSigns of congenital syphilis Wimberger signX-ray knee bilateral erosion in upper medial end oftibia(T )

1) SIGNS OF LATENT TETANY- It can be elicited by the following signs a) Trousseau's sign-Ischemia of the upper limb is caused byinflating a sphygmomanometer cuff above the arterial pressure. This willprecipitate the carpopedal spasm. b) Chvostek's sign-The facial nerve is tapped at its exit from thestylomastoid foramen. This leads to brief twitching of the facial muscles. c) Peroneal sign- d) Erbs sign e) Hyperventilation will precipitate latent tetany.

2) THALASSEMIA Hair on end appearance in X-ray skull

3) SIGNS OF THYROTOXICOSIS- a) Von Graefe sign- Lag of the upper lid on downward gaze. b) Stellwag sign-Infrequent blinking c) Dalrymple sign-(Lid retraction) Staring appearance d) Joffroys sign-Absence of wrinkling on the forehead on lookingupwardse) Moebius sign Lack of convergence of the eye ball f) Widening of palpebral fissures g) Jellinek sign- Hyperpigmented lid skin h) Kochers sign- Frightened ,staring look.4) TUBERCULOSISSign in ileocecal tuberculosis a) Fleischner sign- Inverted umbrella defect due to a wide gapbetween the thickened patulous ileicecal valve and narrowed ulcerated terminalileum . b) Stierlins sign- Th e terminal ileum empties in to the stenoticascending colon with non-opacification of the fibrotic and contracted caecum.(V)1) SIGNS IN DEEP VEIN THROMBOSIS a) Moses sign-On pressing the calf muscles directly ,tendernesswill be present b) Pratts sign-Calf tenderness on squeezing the calf from thesides. c) Homans sign-Calf tenderness on forced ankle dorsiflexion. d) Phlegmasia alba dolens-Painful white leg. e) Phlegmasia cerula dolens-Painful blue leg

2) SIGNS OF VITAMIN DEFICIENCIESa) Signs of Vitamin A deficiency Bitots spots Xerosis (Corneal & conjunctival) KeratomalaciaToad skin-Phrynoderma

b) Signs of Vitamin D deficiency-Rickets-Bossing of skull, Rachitic rosary,Harrison sulcus, genu varum ,genu valgus, Genu recurvatumHot cross bun appearance of skull, widening of wrists, double malleoli,Craniotabes

X ray signs in Rickets X-ray wrists - Cupping and fraying - saucer like epiphyseal endc) Signs of Vitamin K deficiency-Petechiae, purpura

d) Signs of Vitamin E deficiency-Anemia (hemolytic)

e) Signs of Vitamin B deficiency -Angular stomatitis,cheilosis-PellagraBeri Beri-Thiamine, Edema-Wet beri beri, neuritis Dry Beri beriDermatitis Niacin-Casal necklaceGlossitisJerks- Ankle jerk (Vitamin B12 )

Tongue Magenta red tongue-in riboflavin deficiencyBeefy red tongue(Red ,painful ,swollen)-Niacin deficiency Bald tongue- Vitamin B 12 deficiency.Vascularisation of cornea , Angular stomatitis ,Angular blepharitis- Riboflavindeficiency . KeratitisSeborrhoeic dermatitis -Face ,Scrotum.

f) Signs of Vitamin C deficiency-Bleeding gums, woody leg SIGNS IN SCURVY-Bony changes are more around the knee joint a) Corner sign Projection of the white line laterally away from thelimit of the shaft will lead to formation of spur or marginal cleft.

b) Pelkens sign-Pelken spur- due to fracture of the Metaphyseal corner.

c) Wimbergers sign

d) White line of Frenkel Thickened provisional zone (The zone of provisionalcalcification at the epiphyseal ends of long bones.) White line of Frenkel isdue to increased density at the ends of long bones.

e) Pseudoparalysis of parrot

f) Signet ring sign- Signet ring appearance of epiphysis. ( Ring like epiphysis) The rarefied epiphyseal centres may be sharply outlined which is termed signetring.

g) Trummer feld zone (fragmented metaphysis)- Trummefeld zone is rarefactionproximal to the white line.

h) Ground glass appearance of the shaft (Due to rarefaction)

i) Pencil cortex-Thinning of the cortexMISCELLANEOUS-1) Soft neurological signs - Buttoning cloths, tying shoes, movements ofhands.2) Conditions associated with cherry red spot-Sphingolipidoses (Tay sachs disease GM 2 type 1, Sandhoff variant)Niemann-Pick diseaseMetachromatic leucodystrophyMucolipidoses.

3) Tension signs in lumbar disc herniationLasegues testBow string signSitting root test

4) Babinskis sign - By stroking the lateral aspect of the dorsum of the footPositive response - There is contraction of Tibialis anterior, hamstrings, and tensorfascia lata.Components 1) Dorsiflexion of great toe 2) Extension and fanning of other toes 3) Dorsiflexion of their ankle 4) Flexion of the knee 5) Flexion of the hipThe other methods of eliciting plantar extensor reflex- In pyramidal tract lesions, there is an increase in the reflexogenic area. Hence the reflex may be elicited even by stroking the skin high above in theleg.a) Oppenheims sign Heavy pressure is applied by the thumb and index fingerfrom above downwards to anterior surface of tibia (to its medial side). Theextensor response usually occurs towards the end of the stimulation. b) Gordons reflex Squeezing or applying deep pressure to calfmuscles or tendo-achilles produce extensor plantar response.c) Chadocks sign Extensor response is seen after striking the skin around thelateral malleolus in a circular fashion.d) Bing sign Pricking the dorsum of foot by a pin produces extensor response. e) Moniz sign Extensor response is seen after forceful passiveplantar flexion of ankle. f) Gonda sign Extensor response is elicited after forcefulstretching or snapping of distal phalanx of either of the 2nd or 4th toe. g) Brissauds reflex In patients with absent toe or amputated toethe plantar extensor response cannot be seen by observing the great toe sincesuch cases look for the contraction of the tensor fascia lata.PSEUDO-BABINSKI'S SIGN The plantar extensor response may be seen in the absence ofpyramidal tract lesions inn the following conditions 1) Voluntary withdrawal 2) In plantar hyperaesthesia 3) Strong or painful stimulus, 4) In extrapyramidal lesions5) Release reflexesa) Hoffmans sign The terminal phalanx of middle finger to be grasped by theexaminer.The hand to be pronated. Sharp flickering movement of terminal phalanx willproduce adduction and flexion of the thumb and flexion of the other fingerssignifies pyramidal lesion.b) Rossolimos Sign-Plantar surface of the Great toe is tapped with a hammer orflick the distal phalanges of the toes into extension and then allow them tofall back to their normal position. In pyramidal tract lesions, there will beplantar flexion of all the other toes including the Great toe. (This isequivalent of Hoffmans sign of the upper limbs)X-RAY SIGNSThe X-ray changes (in the skull) in increased intracranial tension Widened sutures Erosion of posterior glenoids Silver beaten appearance, Deep sella turcica- Air crescent (Meniscus) sign- when an intracavitary body is surrounded by acrescent of air.(In fungal ball aspergilloma )- Bare area sign- is seen in pleural effusion .The peritoneal ligament preventsascitic fluid from extending over the entire posterior surface of the liver,where as in pleural space, the pleural fluid may extend over the entireposterior costophrenic recess behind the liver.- Double bubble sign- Duodenal atresia- Double decidual sign-in normal intrauterine pregnancy- Goldens sign-hilar mass with collapse.- Hoffman Riglers sign-to assess the left ventricular enlargement in a lateralfilm . ?he distance from the posterior aspect of the inferior vena cava to theposterior border of the heart horizontally at a level 2 cm above theintersection of diaphragm and inferior vena cava.- Interface sign- is seen in pleural effusion .interface between the spleenand the pleural fluid will be less sharp than that of between the liver spleen and ascites.- Nicoladonis or Branhams sign- in proximal AV fistula.- pencil in cup deformity -Psoriatic arthritis-X ray shows pencil in cup deformity of distal inter phalangeal joints.- Rail road calcification- Struge Weber syndrome- Westermarks sign - an area of pulmonary under perfusion in acute massivepulmonary embolism. There is focal oligemia in the embolised zone.ANGIOGRAPHY- Sting of beads Segmental irregularity of medium and small sized arteries infibromuscular dysplasia.PYELOGRAM-- Ring sign- papillary necrosis.BARIUM MEAL- Frostbergs inverted 3 sign- in carcinoma head of pancreasERCP- Double duct sign in carcinoma head of pancreas.BARIUM ENEMA-- Claw sign (Pitch fork sign) in intussusception.FIRST SIGNS1) First sign of puberty in males Testicular growthEARLIEST SIGNSa) Earliest radiological sign of rickets is widening of epiphysisb) Earliest clinical sign of rickets in 6 months old child is Craniotabes.c) Earliest clinical sign of Volkman ischemic contracture Passive stretch pain.- Ortalanis sign of jerk is the earliest sign of congenital dislocation of hip.- Earliest sign of clubbing- increased fluctuation of the nail bed. (loss ofnormal onychodermal angle is a reliable sign)- Early sign in scurvy is seen around the kneesThe following are some conditions with their early signs.-- Ectropion- Visible punctum- Retrolental fibroplasia- New vessel formation- Siderosis- Radial opacities in the lens- Sympathetic ophthalmitis- Keratic precipitates- Glaucoma- Ring of blind spot- Encephalitis lethargica- Ptosis- Basal cell carcinoma- Field defect- Myositis ossificans- Limitation of movement, firm lump in front of the elbow.DEFINITE SIGNOsteomyelitis-Periosteal new bone formation.(appears by the end of second week )Fracture- presence of a deformity in a long bone after injury

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