SIGNS IN MEDICINE---IMP LIST

(A)
- Aarons sign seen in appendicitis. On firm pressure over the McBurneys point
the patient with appendicitis will feel distress in the epigastrium or
precordial region.
- Abadiesign - This is the test of Muscle sense .Compress or squeeze big
muscle bellies (calf,` triceps or biceps)and note whether the patient complains
of 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 , nevoid
basal cell carcinoma ,turner and Larsen .In the presence of short fourth
metacarpal ,there will be a dimple at the metacarpophalangeal joint.
- Alfred Demusset sign- Bobbing of the head with each heart beat. The rapid
blood flow in the carotids will push the head with each beat, thus leading to
movement 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 be
flexed at a right angle and the upper part of the tibia is pulled forward and
pushed backward. Increased anterior and posterior movements will indicate the
rupture 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 bleeding
spots 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.

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- 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 on
the left side.
- Ballentyne-Runge sign - Decrease in the abdominal circumference late in
pregnancy due to placental insufficiency
- Banana sign the frontal lobes will be concave .This is due to neural tube
defects
- Barbers chair sign in multiple sclerosis. An electric shock like sensation
which radiates in to the arms., down the back to the legs, when the patient
flexes the head..
- .Barlows sign- Von Rosens sign In congenital instability of the hip joint
the hips are held flexed and abducted , A click can be heard when the femoral
head leaves the acetabulum
- Bastedos sign seen in chronic appendicitis. On inflation of the colon with
air ,pain and tenderness will be present in the right iliac fossa.
- Battles sign-blood pigment stain behind the ear over the mastoid due to
basal skull fracture (Sphenoid bone )
- Beak sign - in patients with Hypertrophic pyloric stenosis. ,abrupt cut of the
barium 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 umbilicus
will 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 .During
inspiration the umbilicus shifts upward and toward the side of the paralysed
diaphragm
- Bendas sign- This is of importance in tuberculous meningitis. Here the child
has spasm of the trapezius muscle with the result that the shoulder on affected
side is raised up and at times also brought forward. The sign is elicited by
turning the head and chin to one side and if there is upward and forward lifting
of 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 upper
eyelid. It is the earliest sign of facial nerve paralysis.
-Bergman sign (Chalice sign)-is a finding in renal imaging studies where there
is
dilatation of ureter distal to a neoplasm. Such dilatation will be
absent in calculus or thrombus.
- Bing sign Pricking the dorsum of foot by a pin produces extensor response.

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-Blue berry muffin sign- is seen in dermal metastases of Neuroblastoma .There

will be raised purple skin lesions.
- Blue dot sign-is seen in torsion of appendix testis .The appendix that has
undergone 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 other
conditions. In acute cholecystitis there is a referred pain to the right
scapula. There is an area of hyperaesthesia between the ninth and the eleventh
ribs posteriorly on the right side..
- Bows sign-Seen in septicemia in infants. The right side of the mediastinal
shadow resembles a bow.
- Bow string sign-is used in lumbar disc herniation. It is a variation of
straight leg raising test. When the leg is raised pain will occur. At the point
of pain, the knee will be flexed which will reduce the pain.
- Branhams sign- (see Nicoladonis sign) is seen in aretrio venous fistula .The
swelling due to arteriovenous fistula disappears on applying pressure on the
artery proximal to the fistula, thrill and bruit will decrease and the pulse
rate fall .the pulse pressure will return to normal.
- Brim sign- is seen in Pagets disease.
- Braxton Hicks sign-Intermittent uterine contractions can be detected by
palpation after 16 weeks of gestation in pregnancy.
- Brudzinskis sign is seen in meningitis
Flexion of one lower limb causes flexion of opposite limb immediately. It is
the 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 the
hips as well as knees. This is a common sign of meningitis in infancy. There
may be minimum flexion of the lower limbs when the child has paraplegia or
quadriplegia; there is unilateral flexion of the unaffected limb. This not only
helps 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 hip
and 90-120 at knee. While trying to extend the lower limbs there is flexion of
the opposite limb at the hip and knee. This is a positive Brudzinskis leg
sign. In children who are constantly moving the lower limbs, particularly in
the first 2-3 years of life, the test should be carried out 3 to 4 times before
it is concluded as positive. If a child has weakness or paralysis of the
opposite limb there may be minimum flexion at the hip and knee.)
- Bruns sign- Excruciating headache , vertiginous episodes , coma and death
due to sudden movement of the head ,if the cysts are present in the fourth
ventricle .
- Bryants sign-in shoulder dislocation .Abnormal position of axillary folds.

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- Bulge sign- Small effusion in the knee joint. Apply gentle pressure first on
the medial side of the joint when the patient is lying with the quadriceps
relaxed. 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 posterior
acetabular margin will cut across the medial corner of the metaphysis. In this
condition the entire metaphysis will remain lateral to the posterior acetabular
margin.
- Cardarellis sign- transverse pulsation in the laryngotracheal tube in
aneurysms and dilatation of the aortic arch.
- Carmans Meniscus sign- A radiological finding seen in malignant gastric
ulcer. Meniscus shaped gastric ulcer with the concavity pointed towards the
gastric lumen
- Carpet tacks sign- is seen in Discoid Lupus Erythematosis (DLE)
- Carvallos sign- In cases with ASD, the tricuspid murmur is maximal at the
lower 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 seen
after 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 in
achondroplasia.
- Chvosteks sign -The facial nerve is tapped at its exit from the stylomastoid
foramen. This leads to brief twitching of the facial muscles, ala of the nose
and the blinking of the eyelids. .Elevation of the corner of mouth may b e seen.
- Coffee bean sign- Strangulation of incompletely obstructed loop of small
bowel.
- Coin test-is found in tense Pneumothorax. Place a metallic coin on the upper
part of the affected chest, and percuss over the coin with another coin. Listen
at the same time from the back with the diaphragm of a stethoscope. A high
pitched tympanitic bell-like metallic sound can be heard in the presence of
Pneumothorax.
- Colemans sign- Hematoma over the floor of the mouth in fracture of body of
mandible.
- Combys sign-is seen in measles. In early stages thin whitish patches are seen
on the gums and buccal mucous membranes.

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- Commandos sign-in spastic cerebral palsy the child drags the feet like a
rudder.
- Coopers sign- In acute appendicitis, the tenderness is elicited in the left
lateral position.
- Corners sign- seen in scurvy. A groove will be present just above the zone of
provisional calcification.
- Corrigan's sign - Dancing carotids in aortic regurgitation..
- Counting sign-in diaphragmatic paralysis ,the patient cannot count more than
10 in one breath.
- Coupdongue sign- Tinea versicolor.
- Courvoisier sign- Gall bladder will be palpable in patients with carcinoma
head 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 the
collecting ducts compressed by the dilated calyces.
- Crowes sign In neurofibromatosis , axillary freckling and speckled
hyperpigmentation over the upper chest ,groin and perineal region will be
present .
- Cruveilhier s sign-is seen in portal hypertension. Caput medusa due to
portocaval anastomosis.
- Cullen sign-A bluish discoloration seen around the umbilicus in patients with
acute 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 line
will be seen.
- Dance sign- in intussusception. The right lower quadrant may feel empty to
palpation in intussusception.
- Darier sign- Urticaria pigmentosa. The lesions tend to become red, itchy and
urticarial if they are rubbed.
- Dalrymple sign-(Lid retraction) Staring appearance due to abnormal widening
of palpebral fissures in hyperthyroidism

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- Dawbarns sign- seen in subacromial bursitis .The pain in this condition will
disappear 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 iliac
fossa in acute intussusception.
- D Espines sign-A large mediastinal node or a mass in Bronchogenic carcinoma
may transmit the tracheal sound .This can result in bronchial breath sound,
whispering pectoriloquy and rarely egophony in the inter scapular region.(Below
D4)
- 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 zone
of reduced density visible around the head of relatively mature fetus before
delivery appears to be separated from the cranium .The density of this zone will
be similar to that of the soft tissues. This can be demonstrated radiologically
within 3 days after the death of fetus.
- Dimple sign- Cart-Wheel pattern of fibroblast seen in Dermatofibrosarcoma
protuberans.
- 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 conditions
Duodenal 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 pericardial
effusion.
- 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 be
able 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 distal
compression.
(E)

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- Emptying sign in straw berry angioma

- Erbs sign-seen in latent tetany. Muscular contractions can be produced by
application 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 basal
segments due to large pericardial effusion.. There will be dullness on
percussion, increased vocal resonance, tubular breath sounds., increased vocal
resonance. 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 from
the second day of the illness.
- Falling fragment sign-Solitary bone cyst.
- Fat pad sign-is seen in pericardial effusion .In normal persons the parietal
pericardium is separated from the epicardial fat by about 1-2 mm. This is
increased in pericardial effusion.
- Felson s silhouette sign- any intrathoracic mass touching the heart ,aorta or
diaphragm will obliterate that border on the chest X ray.
- Fistula sign- Pressure changes can be transmitted to the membranous
labyrinth if there is a fistula in the bony labyrinth. Pressing the tragus will
induce jerk nystagmus.
- Fitzpatrick sign-in dermatofibroma .There will be dimpling when the mass is
squeezed on both sides.
- Flag sign- Flag sign may be seen in Kwashiorkor. The hair will be alternately
normal and depigmented. The hair in cases of severe malnutrition will be
hypopigmented. As the nutrition improves the pigmentation of the hair will be
normal. 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 the
falciform ligament indicates perforation and needs surgical
treatment.(Pneumoperitoneum)

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- Forscheimer sign- Enanthem in rubella.

- Foresters sign-In hypotonic or Atonic cerebral palsy, when the child is
lifted 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 will
be straight while holding the book . In patients with ulnar nerve palsy the
terminal 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 will
be lowering of the knee on the affected side when the child lies prone with hip
flexed 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 or
snapping of distal phalanx of either of the 2nd or 4th toe.
- Gowers sign- is seen in Duchenne muscular dystrophy ,.It will be evident by 3
years of age and will be fully expressed by 5-6 years of age. Climbing upon his
own 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 co
movements. There will be inability to keep the fingers stretched and together.
- Grey Turners sign-A bluish discoloration seen in the flanks in patients with
acute hemorrhagic pancreatitis.
- Griesingers sign- is seen in lateral sinus thrombosis. The thrombus may
extend and result in indurated tender area over the upper part of the internal
jugular vein and mastoid region.
- Groove sign- Lymphogranuloma venereum (LGV) The enlarged lymph nodes are seen
both above and below the inguinal ligament.
(H)
-Halo sign.- Severe erythroblastosis with hydrops fetalis is demonstrable by
extensive edema, which elevates fat layers beneath the skin to produce a halo
sign. The so-called Buddha position is also indicative of hydrops fetalis
- Halo sign in breast tumour - a narrow radiolucent ring surrounding a benign
breat lesion.
- Hammans crunch sign -crackling ,bubbling, crunching and churning sounds
heard over the precordium in pneumomediastinum..It is better heard during the

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systole in left lateral position in expiration.

- Head drop sign - The patient is asked to lie down. The shoulders are raised
off the bed. Usually the head also will raise but in this case the head lag
will occur. Children with poliomyelitis are unable to lift the head or bring it
along 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; of
liver and the abdominal wall.
- Hegar s sign-Softening of the isthmus or the lower segment of the uterus This
can 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 uterine
contractions which increase in frequency and intensity as the pregnancy
advances.
- Higoumenakis sign-Enlargement of the medial end of the clavicle which is a
late feature of syphilis.
- Hill's sign-is seen in Aortic Regurgitation .The systolic pressure in the
lower limb is more than that of the upper limb .Normally this pressure
difference will be less than 20 mm of Hg. The severity of the aortic
regurgitation 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 160
degrees
- Hoffmans sign is significant of pyramidal lesion. The terminal phalanx of
middle finger to be grasped by the examiner. The hand to be pronated. Sharp
flickering movement of terminal phalanx will produce adduction and flexion of
the 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 finger
with pain on extension.
- Hoovers sign is seen in pleural effusion .There will be decreased chest
movements on the affected side in pleural effusion.
- Hoovers sign(for unilateral weakness or paralysis of one leg )- is done to
differentiate between paralysis and Pseudoparalysis of one leg .The examiners
hand is placed under the heel of the paralysed leg .Now ask the patient to raise
the normal leg against resistance .In normal individuals the examiner can feel
the pressure by the normal leg ..This will be absent if the leg is weak or
paralysed.

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- Hutchinsons sign- In Herpes Zoster ophthalmicus, when the tip of the nose is
involved ,the eye also will, be involved. This is because both the area are
supplied 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 will
be 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 in
thyrotoxocisis.
(K)
- Kanavels sign- In infection of ulnar bursa ,there will be tenderness over
the 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 pain
is due to the contact of blood in the under surface of diaphragm .The pain is
mediated through the afferent fibres of the Phrenic nerve.
- Kernigs sign-The patient lies supine .The hip is flexed and the knee is
extended passively. In patients with meningitis there will be pain and spasm of
hamstrings.
It is positive in meningeal irritation and sub arachnoid haemorrhage. It is
relatively less important in infancy and early childhood as it may be negative
in spite of meningeal involvement. However, it is a very useful sign in older
children.
- Kestenbaums sign- is seen in optic atrophy. The number of capillaries that
cross 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 and
the index finger In patients with anterior interosseous syndrome, fine pinch
posture is abnormal.
- Kiss the-knee sign- Ask the child to sit and kiss the knee. In the presence
of 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 an
abrupt tapering of the vessel distal to the occlusion.
- Kritchleys sign (Cortical thumb) in pyramidal tract lesion.
- Kussmauls sign- Inspiratory prominence of jugular veins in pericardial
effusion, constrictive pericarditis, restrictive cardiomyopathy..
(L)

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- Ladins sign-is seen in pregnancy. There is softening of the medial anterior

surface 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 beats
and not related to light reflex.
- Lassigue sign-A positive leg rising test .It is present in sciatica, prolapsed
intervertebral disc. With the patient lying supine, ask him to elevate the
extended leg .A normal person can extend up to 90 degrees. The test is positive
if the movement is restricted.
- Lemon sign- See banana sign the frontal lobes will be concave .This is due to
neural tube defects.
- Leris sign- is seen in hemiplegia. There will be absence of normal flexion of
the elbow on passive flexion of the hand at wrist on the affected side.
- Leser-Trelat sign- is seen in internal malignancy. There will be sudden
appearance of large number of keratosis.
- Lhermittes sign- electric shock like sensation radiates down the trunk ,when
the trunk is flexed .it indicates cervical cord lesion ,cervical spondylotic
myelopathy, sub acute combined degeneration of the cord, radiation myelopathy
- Light house sign - alternate flushing, and blanching of the forehead in Aortic
Regurgitation
- Light house sign in acute Suppurative otitis media.. a pulsating discharge
will reflect the light intermittently.
- Littens sign- in diaphragmatic palsy .There is absence of indrawing of
subcostal margin during inspiration.
- Ludloffs sign is seen in avulsion fracture of the lesser trochanter. There
will be inability to flex the stretched leg, when the patient is seated.
(M)
- Macewens sign (Crack pot resonance) - a cracked-pot sound on percussion
of the skull, may be present with hydrocephalus, increased intracranial pressure
and sutural separation. It is due to separation of sutures in a child having
increased intracranial tension. It is also simulated in many normal infants. To
elicit this sign the childs head should be lifted up from the bed and supported
by putting the examiners hand under the neck In children who can sit up this
can be done in the sitting position. A sharp tap with the middle finger is
given 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.

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- Marions sign-seen in benign prostatic enlargement.

- Mathes sign-In patients with perinephric abscess, the kidney does not descend
down in erect posture .In normal persons the kidney will descend in erect
posture .
- Maxwell-Lyons sign-is seen in vernal conjunctivitis. A fibrinous
pseudomembrane may be seen.
- Mc Burneys sign-In acute appendicitis; pain can be elicited at the Mcburneys
point 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 the
flexed tibia is rotated upon the femur.
- Melting sign- In pulmonary embolism with infarction .The consolidation
regresses from periphery to the centre.
- Mercedes Benz sign (Seagull sign) When gas is present in the gall stones, a
characteristic dark shape will be seen in the X ray
- Milians ear sign- Erysipelas can spread in to the pinna (cellulitis cannot
spread as there is no areolar tissue )
- Milk maid sign-Ask the patient to hold the examiner's hand,(index and middle
fingers can be placed together).Feel for the uniformity in the force of
contraction by the patient. Ask the patient to hold the fingers of opposite hand
and compare with the other side. In the affected side there will be alternating
forces (contractions and relaxations),as like milking of a cow.
- Meniscus sign- seen in X-ray , when a mobile mass is present in the
pulmonary 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 flexion
of ankle
- Moses sign-In venous thrombosis, pain can be elicited by squeezing the calf
muscles.
- Moulage sign-is seen in Malabsorption syndrome .It is due to flocculation and
segmentation 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 eye
lid when the patient looks down.
- Murphys Sign: Ask the patient to breathe in deeply and palpate for gall
bladder. At the height of inspiration the breath is arrested with a gasp as the

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mass is felt. This is the sign of acute cholecystitis.

(N)
- Naffzigers sign-Stand behind the patient and look vertically downwards in the
plane of super ciliary ridges .The eye balls can be seen protruding out of this
plane 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, Stevenson
Johnsons 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 in
patients with COPD. The chin should be raised and upward pressure should be
applied over the trachea. A downward traction can be felt on the trachea. This
is known as tracheal tug.
- Oppenheims sign Heavy pressure is applied by the thumb and index finger
from 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 congenital
dislocation of hip. By holding the limbs with the hip and knees flexed ,abduct
the hip joint.Placea finger over the greater trochanter.A click can be felt as
the 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 of
the anterior cranial fossa.
- Pardees sign- It is an electrocardiogram finding in myocardial infarction. A
few hours after the infarction there will be a Q wave and S-T segment is
elevated.
- Pastias sign-is seen in scarlet fever .Residual petechial lesions in the
antecubital fossa.
- Peroneal sign-Seen in latent tetany. Tapping the peroneal nerve at the neck of
the fibula will produce dorsiflexion and abduction of the foot.(eversion of
foot )

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- Patellar apprehension sign-apply lateral pressure to the patella with the knee
extended to 30 degrees .and the quadriceps relaxed .The patient fears that the
patella may be dislocated and extends the knee thereby relocating the patella
to the normal position.
- Patellar tap sign- is seen in knee joint effusion. The effusion delays the
patellar tapping against the femur. ,when it is pressed firmly and quickly.
- Pedestal sign- is seen in cementless total hip arthroplasty, when there is
prosthetic 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 ,the
face is suffused, due to the pressure by the thyroid on the SVC
- Penetrating sign-A radiological finding in benign gastric ulcer. The ulcer
crater should project from the contrast filled lumen and erode in to the stomach
wall rather than in to the mass in the stomach wall.
- Phalens sign-In carpel tunnel syndrome ,the signs and symptoms will increase
on flexion of the wrist .On straightening these will improve. This is also known
as 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 or
retraction 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 to
180 degree or limited joint mobility of interphalangeal joints of at least one
finger bilaterally.
- Prehns sign- is seen in epididymo -orchitis .On elevation of the testis the
pain increases in torsion and in epididymo-orchitis the pain decreases.
- Pronator sign-Ask the child to hold the hands above the head with the palm
facing each other for some time. The patient will not be able to hold it in
same position. The hand on the affected side will be pronated and the palm will
face outwards
- Pseudo-babinski's sign
The plantar extensor response may be seen in the absence of
pyramidal tract lesions in the following conditions
1) Voluntary withdrawal
2) In plantar hyperaesthesia
3) Strong or painful stimulus,
4) In extrapyramidal lesions

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- Pseudo Darrier sign- Congenital smooth muscle hamartoma

- Puddles sign -To diagnose minimal ascites. The patient is put in knee chest
position .Percuss the abdomen towards the umbilicus to elicit the dullness.
(Q )
- Quinke's sign (In aortic regurgitation) There will be alternate flushing and
blanching in the nail bed.
(R)
- Raccoon eye sign-is seen in fracture of the base of the skull. Bilateral
ecchymosis and swelling of the upper eye lids will be present..
- Red dot sign-Abdominal wall is discolored with focal or diffuse erythema
reflects underlying peritonitis. This sign is seen in neonatal necrotizing
enterocolitis.
- Reissers sign-iliac apophysis fuses with the iliac bone at maturity .This
indicates 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, in
Pneumoperitoneum.
- Rim sign-In severe hydronephrosis some times only a thin rim of the contrast
will be seen outlining the kidney. This is due to the contrast medium
circulating in the capillaries compressed by the dilated calyces.
- Roberts sign- appearance of gas shadow in the heart and great vessels by 12
hours of fetal death
- Romanas sign- in Chagas disease ,.there will be unilateral painless oedema
of 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 is
special test to find out the Co-ordination of the lower limbs. The patient is
asked to stand with his feet close together with both his eyes opened and
closed. If Rombergs sign is present as soon as the patient closes his eye, he
begins to sway or may even fall, It signifies sensory ataxia.
- Rope sign- due to constriction of hypopharynx in poliomyelitis. There is acute
angulation 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 or
flick the distal phalanges of the toes into extension and then allow them to
fall back to their normal position. In pyramidal tract lesions, there will be
plantar flexion of all the other toes including the Great toe. (This is
equivalent of Hoffmans sign of the upper limbs)
- Rotchs sign- Flat note in the cardio hepatic angle on the right side in

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pericardial effusion .
- Rovsings sign-In appendicitis, when the abdomen is pressed on the left iliac
region ,there will be pain in the right side. This is due to the stretching of
the inflamed peritoneum on the right side.
(S)
- Sail sign- The sail shaped shadow of the thymus in the upper mediastinal
shadow.
- Sandwich sign- Mesenteric adenopathy.
- Schamroths sign .This is seen in clubbing .Normally when the thumbs are
placed in close approximation to each other so that the nails are facing each
other 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 called
Shamroth sign.
- Scarf sign- The elbow crosses the midline when the arm is crossed across the
chest .Keep the head in the midline pull the hand across the chest .The elbow
will cross the midline in preterm babies..
- Schwartz sign- is seen in Otosclerosis. A pink tinge may be seen due to
otospongiotic mass (Flamingos tint)
- Scimitar sign- Crescentic shadow (Curved Turkish sword shaped shadow) of
vascular density along the right border of the cardiac silhouette. This is due
to anomalous pulmonary vein draining in to the inferior vena cava.
- Scottish dog sign- is seen in spondylolysis. The defect is in the pars
interarticularis.. 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 internal
rotation of the hip will be full with hip extended ,but will be grossly
restricted with the hip flexed.
- Seidels sign- Sickle shaped extension of the blind spot above or below ,or
both ,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 sclera
above the upper limbus will not be visible. In hydrocephalus , eyes deviate
downward because of the impingement of the dilated suprarenal recess on the
tectum. .In normal new born babies this may be visible transiently. In
kernicterus and hydrocephalus it will be persistent
- Shawl sign- In dermatomyosistis .there will be erythema over the upper back
and shoulders.
- Shoulder sign-The hypertrophied pyloric muscle will cause an indentation of
the barium filled antrum in patients with Hypertrophic pyloric stenosis.
- Shrug sign is seen in patello-femoral osteoarthritis.There will be pain ,when
the patella is compressed manually against the femur during quadriceps

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contraction.
- 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 in
children with inguinal hernia. .It is elicited by palpating the spermatic cor d
at the pubic tubercle.
- Soft neurological signs is a particular form of deviant performance on a
motor or sensory test in a neurological examination that is abnormal for a
particular age. These are present in normal children at some stage of their
development like .repetitive and successive finger movements, foot taps,
hopping, tandem walking.
- Spaldings sign- This is a radiological feature of intrauterine death
overlapping of the skull bones at the sutural lines and shrinkage of the skull
contents in fetal death.
- Spatula sign- In tetanus, spasm of the child will be aggravated, when the
childs mouth is pressed with a spatula.
- Spooning sign is seen in chorea. Ask the patient to stretch the arms forward
and hold them parallel to the floor with the palms facing each other. The
affected arm will be flexed at the wrist and extended at the metacarpophalangeal
joints.
This resembles a dinner fork.( Dinner fork deformity)
- Steeple sign in croup.
- Steinberg sign- ( Thumb sign) -In Marfans syndrome ,Protrusion of the thumb
beyond 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 bubbles
of gas may be trapped between the valvular conniventes
- Square root sign- on right ventricular pressure tracing in constrictive
pericarditis.
- Stellwag sign-(Staring look ) Infrequent blinking in Thyrotoxicosis.
- String sign-is seen in Hypertrophic pyloric stenosis. In barium meal study the
elongated pyloric canal will be seen as a single line of barium. Some times it
will be seen as a double line.
- String sign of Kantor- in barium meal study.-Crohns disease is due to the
marked narrowing of the affected bowel.
- Sulcus sign a radiological sign in inferior dislocation of shoulder ,where
the head of the humerus lies below the glenoid.

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- Sun setting sign-See setting sun eye sign.

- Suzman's sign-In Coarctation of aorta collaterals are formed in the back and
will cause pulsations over the back.. The pulsations are prominent over the
scapula 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 like
a 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 the
plate and through the part of the metaphysis.
- Tinels sign-When a regenerating nerve is tapped at the level of regeneration
there will be a tingling sensation
- Tragers sign
This is a sign of fetal death in utero. The fetal attitude in a X-ray will be
with marked curvature or collapse of spine. Loss of fetal attitude or posture is
a result of decreased muscle tone .
- Trail sign- Undue prominence of clavicular head of sternomastoid muscle on
one side is indicative of tracheal displacement to that side .
- Tram track sign-Double track of barium will be seen outlining the Hypertrophic
mucosa 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 aortic
regurgitation
- Trendelenburg sign-in congenital dislocation of hip. Ask the patient to stand
on one leg and note the position of the pelvis. If the test is negative the
pelvis will be raised on the unsupported side .If the test is positive the
pelvis will drop on the unsupported side.
- Trethowans sign- is positive in slipped femoral epiphysis. Normally the line
drawn 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.

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- Tripod sign is seen in poliomyelitis. The child sits with the knees flexed and
both the hands placed behind him supporting on the back as if in the tripod
position. On stretching the legs the meninges are stretched which aggravates
the pain. By assuming the tripod position the stretching of the meninges is
avoided thereby the pain is reduced.
- Troisiers sign enlarged left supraclavicular node (Virchows node)due the
gastric malignancy.
- Trolley track sign -Signs in Ankylosing spondylitis Three vertical linerar
lines 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 a
sphygmomanometer 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 the
nerve root seconday to edema.
- Throgmortons sign-Extension of the suspensory ligament of the penis prior to
micturition in newborn infants.
(V)
- Vacuum cleft sign- is seen in vertebra plana.
- Vallecular sign-Retention of barium in hypopharynx in patients with carcinoma
of larynx.
- Vascular sign of Narath- is seen in anterior dislocation of the hip joint. The
femorals are easily felt in Scarpas triangle.
- Verumonten sign- is seen in complete rupture of urethra. The prostate will be
floating 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 joint
the hips are held flexed and abducted , A click can be heard when the femoral
head leaves the acetabulum .
- Victor Horsleys sign-The temperature will be 1-2 degree more on the
paralysed side.
(W)
- Water Lily sign- Hydatid cyst.
- Watenberg 's sign.-The fingers of the hand to be examined should be flexed and
interlocked to the examiners flexed fingers. A pull in the opposite direction
should be applied , so that the fingers of each other pull against other's
resistance. Normally the thumb extends. In the presence of cortical lesions the
thumb adducts and flexes.

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- Wimbergers signX-ray knee bilateral erosion in upper medial end of tibia. It

will be seen in congenital syphilis ,scurvy .
- Winter bottom sign- is seen in Trypanosoma brucei infection African
trypanosomiasis (Sleeping sickness).The regional nodes enlarge in the posterior
cervical triangle..
- Wredens sign- is seen in a stillborn baby. Gelatinous material more or less
completely fills the external auditory meatus.
- Wrist sign-It is seen in Marfans syndrome. Ask the patient to grasp the wrist
with the thumb and the little finger. There will be overlapping of the fingers.
- W sitting- is seen in persistent anteversion of the femoral neck .Children
sit 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 medial
half of the proximal tibial epiphysis (Blounts disease)
- Vital signs- pulse, respiration, temperature.
RADIOLOGICAL SIGNS
Coffee bean sign (Birds beak deformity or ace of spade deformity is seen in
sigmoid 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 cyst
SIGNS 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 SIGNS
The volume output from the left ventricle is high and also there is a diastolic
run off. This causes a rapid filling of the peripheral blood vessels and rapid
emptying of these vessels. This is the cause for the peripheral signs of the
aortic regurgitation.
a) Demusset sign
b) Light house sign - alternate flushing, and blanching of the forehead.

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

d) Landolfi's sign - constriction and dilatation of pupils with the heart beats
and 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 prominently
in 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 nail
bed.
j) Hill's signk) 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 with
the 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 is
elicited 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 liver
and 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, and
pulmonary arteries with less prominent aortic knuckle)
- Hilar dance On fluoroscopy there is conspicuous pulsation of the pulmonary
arteries.
(C )
1) SIGNS IN CARDIAC FAILUREFeatures of left ventricular failure
Cardinal signs of left ventricular failure are
a) Gallop rhythm-S3 will be heard along with S1 and S2 .This is
called 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

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b) Hepatomegaly-soft, tender, may be pulsatile

c) Oedema of dependant parts.-Pedal oedema in patients who are
standing and sacral oedema in recumbent patients.
2) CARDIOMYOPATHY
Signs 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 SIGNS
a) 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 straight
line 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 column
lesions.
Romberg test. The patient is asked to stand straight with both the
feet close to each other .First the patient is asked to stand with the eyes open
and then with the eyes closed. In cases with posterior column lesions where the
position sensation is lost, the patient will fall on the side of the lesion when
the eyes are closed. This is because the patient adapts to the loss of position
sensation by the visual assessment of the positions. When the eyes are closed or
in 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 CHOREAChorea-are semi-purposive ,brief ,jerky, irregular
a) Hypotonia.
b) Jack in box tongue- Involuntary protrusion and retraction of the
tongue.
c) Pronator sign
d) Milk maid sign-(Milking sign)
e) Hung up reflex- With the patient sitting on the bed with the legs
hanging freely the knee jerk is elicited. The extension at the knee joint will
be maintained for some time before the leg comes down. This is called hung up
reflex and occurs in the affected side.

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f) Spooning signg) Emotional lability

h) Czernys sign
6) SIGNS IN CIRRHOSIS LIVER
- Dawsons sign
- Terry nails (leuconychia ) white nails seen in thumb and index
fingers .
- 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 Reflex
CORTICAL 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 will
disappear 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)

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1) SUB ACUTE BACTERIAL ENDOCARDITIS

Anemia
Clubbing- -acute, Tender
Oslers nodes- Painful, Pea sized intradermal nodes
In the Pads of fingers and toes
Janeway lesions-painless, small erythematous, hemorrhagic lesions
in palms and soles
Splinter hemorrhages-beneath the nails
Petechiae
Tender splenomegaly
Microscopic hematuria
Roth spots
(F)
1) False localizing signsIncreased intracranial tension will result in lateral rectus palsy
due 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 deathRoberts sign
Spalding sign
Balls sign
Duels or halos sign
Trager sign
4) Signs of fracture
a)
Crepitus
b) Deformity
c)
Local bony tenderness
d) Abnormal mobility
e)
Shortening of a segment of limb
5) Basilar skull fracture
Four 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 ULCERa) Carmans sign- is seen in malignant gastric ulcer. Meniscus
shaped gastric ulcer with the concavity pointed towards the gastric lumen
b) Penetrating sign-The ulcer crater should project from the
contrast filled lumen and erode in to the stomach wall rather than in to the
mass in the stomach wall.
(H )
1) Signs of congenital dysplasia of hip joint
- Allis sign
Galeazzi signTrendelenburgs sign.
2) Signs of hydronephrosis-

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Rim sign
3) SIGNS IN HYPERTROPHIC PYLORIC STENOSIS.
a) Target sign
b) Tram track signc) String sign
d) Beak sign
e) Shoulder sign
4) SIGNS OF HYPOPARATHYROIDISMa) Trousseau's signb) Chvosteks sign
5) EARLY SIGNS OF HYPOTHYROIDISMProlonged physiological jaundice,
Hypothermia,
Hypotonia,
Mottled skin,
(I )
1) INTUSSUSCEPTION Signs of intussusception are
a) Claw sign
b) Pitch fork sign in barium enema
c) oiled spring deformity
(K)
1) EARLY SIGNS OF KERNICTERUSPoor feeding
Lethargy
Altered cry
Altered behaviour
2) SIGNS OF KNEE JOINT EFFUSION
a) Patellar tap signb) Bulge sign
(L )
1) Lateralizing signs
In coma it will be difficult to recognize the focal neurological signs .The
following features wil indicate the side of the lesion
a)
Menace reflex (Asymmetric hemianopia)
b)
Facial weakness
c)
Abnormal tone
d) Response to painful stimuli
e)
Asymmetry in plantar response
f)
Asymmetry in tendon reflexes
g)
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

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- 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 narrow
palm.
c) Wrist sign(N )
1) SIGNS OF NERVE PARESIS
Ulnar nerve paresis
a) Froments sign
b) Paper test for interosseous muscles
c) Claw hand
Median nerve- paresis . Median nerve is paralysed in Carpel tunnel syndrome
a) Pointing index-Ask the patient to close the fist .The
index finger will be pointing.
b) Simian or Ape like hand (Ape thumb deformity)The
thumb lies in the plane of the hand due to paralysis of the opponens and the
short flexor muscles.
c) Inability ot flex the interphalangeal joints due to
paralysis 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 to
serratus 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 ATROPHY

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Signs of Optic atrophy

Uthoffs phenomenon- Worsening of vision during fever in hot weather
or after exercise .central conduction is slowed by increase in the body
temperature
(P )
1)PANCREAS
SIGNS IN ACUTE HEMORRHAGIC PANCREATITIS.
a) Cullen sign
b) 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. In
the presence of Nuchal rigidity ,the child cannot kiss the knee without bending
the knee.
- Phantom hernia-Bulge seen in the abdominal wall due weakness of
abdominal muscles.
6) SIGNS IN PREGNANCY
a) Hegars sign softening of cervix in pregnancy
b) Osianders sign (Vaginal sign) increased pulsations through
lateral fornices .this occurs by 8 weeks of gestation.
c) Goodells sign (Cervical sign) Softening of the cervix with
bluish discoloration by 6 weeks of gestation
d) Jacquemiers sign (Ghadwicks sign) dusky hue of the vestibule
and the anterior vaginal wall occurs by 8 weeks of gestation
e) Placental sign- Cyclical bleeding occurs up to 12 weeks of
pregnancy.
f) Braxton Hicks signg) Ladins sign

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7) SIGNS IN A PRETERMa) Scarf sign The elbow crosses the midline when the arm is crossed across the
chest.
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 sign2) Signs in scoliosis
Reisser s sign-iliac apophysis fuses with the iliac bone at
maturity .This indicates a completion of growth.
3) SIGNS IN SPONDYLOLISTHESISBeheaded scottish terrior signScotty dog with collar sign
Incomplete ring sign
Inverted Napoleon hat sign is seen in Spondylolisthesis- of the L5
vertebral body.
4) SYPHILIS
Signs of congenital syphilis
Wimberger signX-ray knee bilateral erosion in upper medial end of
tibia
(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 by
inflating a sphygmomanometer cuff above the arterial pressure. This will
precipitate the carpopedal spasm.
b) Chvostek's sign-The facial nerve is tapped at its exit from the
stylomastoid foramen. This leads to brief twitching of the facial muscles.
c) Peroneal signd) Erbs sign
e) Hyperventilation will precipitate latent tetany.
2) THALASSEMIA
Hair on end appearance in X-ray skull
3) SIGNS OF THYROTOXICOSISa) 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 looking
upwards
e) 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) TUBERCULOSIS
Sign in ileocecal tuberculosis
a) Fleischner sign- Inverted umbrella defect due to a wide gap
between the thickened patulous ileicecal valve and narrowed ulcerated terminal

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ileum .
b) Stierlins sign- Th e terminal ileum empties in to the stenotic
ascending 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 ,tenderness
will be present
b) Pratts sign-Calf tenderness on squeezing the calf from the
sides.
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 DEFICIENCIES
a) Signs of Vitamin A deficiency
Bitots spots
Xerosis (Corneal & conjunctival)
Keratomalacia
Toad skin-Phrynoderma
b) Signs of Vitamin D deficiency-Rickets-Bossing of skull, Rachitic rosary,
Harrison sulcus, genu varum ,genu valgus, Genu recurvatum
Hot 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 end
c) Signs of Vitamin K deficiency-Petechiae, purpura
d) Signs of Vitamin E deficiency-Anemia (hemolytic)
e) Signs of Vitamin B deficiency Angular stomatitis,cheilosis-Pellagra
Beri Beri-Thiamine, Edema-Wet beri beri, neuritis Dry Beri beri
Dermatitis Niacin-Casal necklace
Glossitis
Jerks- Ankle jerk (Vitamin B12 )
Tongue Magenta red tongue-in riboflavin deficiency
Beefy red tongue(Red ,painful ,swollen)-Niacin deficiency
Bald tongue- Vitamin B 12 deficiency.
Vascularisation of cornea , Angular stomatitis ,Angular blepharitis- Riboflavin
deficiency .
Keratitis
Seborrhoeic 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 the
limit 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

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d) White line of Frenkel Thickened provisional zone (The zone of provisional

calcification at the epiphyseal ends of long bones.) White line of Frenkel is
due 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 signet
ring.
g) Trummer feld zone (fragmented metaphysis)- Trummefeld zone is rarefaction
proximal to the white line.
h) Ground glass appearance of the shaft (Due to rarefaction)
i) Pencil cortex-Thinning of the cortex
MISCELLANEOUS1) Soft neurological signs - Buttoning cloths, tying shoes, movements of
hands.
2) Conditions associated with cherry red spotSphingolipidoses (Tay sachs disease GM 2 type 1, Sandhoff variant)
Niemann-Pick disease
Metachromatic leucodystrophy
Mucolipidoses.
3) Tension signs in lumbar disc herniation
Lasegues test
Bow string sign
Sitting root test
4) Babinskis sign
- By stroking the lateral aspect of the dorsum of the foot
Positive response
- There is contraction of Tibialis anterior, hamstrings, and tensor
fascia lata.
Components
1) Dorsiflexion of great toe
2) Extension and fanning of other toes
3) Dorsiflexion of their ankle
knee
5) Flexion of the hip
The 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 the
leg.
a) Oppenheims sign Heavy pressure is applied by the thumb and index finger
from above downwards to anterior surface of tibia (to its medial side). The
extensor response usually occurs towards the end of the stimulation.
b) Gordons reflex Squeezing or applying deep pressure to calf
muscles or tendo-achilles produce extensor plantar response.
c) Chadocks sign Extensor response is seen after striking the skin around the
lateral 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 passive
plantar flexion of ankle.

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f) Gonda sign Extensor response is elicited after forceful

stretching or snapping of distal phalanx of either of the 2nd or 4th toe.
g) Brissauds reflex In patients with absent toe or amputated toe
the plantar extensor response cannot be seen by observing the great toe since
such cases look for the contraction of the tensor fascia lata.
PSEUDO-BABINSKI'S SIGN
The plantar extensor response may be seen in the absence of
pyramidal tract lesions inn the following conditions
1) Voluntary withdrawal
2) In plantar hyperaesthesia
3) Strong or painful stimulus,
4) In extrapyramidal lesions
5) Release reflexes
a) Hoffmans sign The terminal phalanx of middle finger to be grasped by the
examiner.
The hand to be pronated. Sharp flickering movement of terminal phalanx will
produce adduction and flexion of the thumb and flexion of the other fingers
signifies pyramidal lesion.
b) Rossolimos Sign-Plantar surface of the Great toe is tapped with a hammer or
flick the distal phalanges of the toes into extension and then allow them to
fall back to their normal position. In pyramidal tract lesions, there will be
plantar flexion of all the other toes including the Great toe. (This is
equivalent of Hoffmans sign of the upper limbs)
X-RAY SIGNS
The 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 a
crescent of air.(In fungal ball aspergilloma )
- Bare area sign- is seen in pleural effusion .The peritoneal ligament prevents
ascitic fluid from extending over the entire posterior surface of the liver,
where as in pleural space, the pleural fluid may extend over the entire
posterior 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 lateral
film . ?he distance from the posterior aspect of the inferior vena cava to the
posterior border of the heart horizontally at a level 2 cm above the
intersection of diaphragm and inferior vena cava.
- Interface sign- is seen in pleural effusion .interface between the spleen
and 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 massive
pulmonary embolism. There is focal oligemia in the embolised zone.
ANGIOGRAPHY
- Sting of beads Segmental irregularity of medium and small sized arteries in
fibromuscular dysplasia.
PYELOGRAM-

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- Ring sign- papillary necrosis.

BARIUM MEAL
- Frostbergs inverted 3 sign- in carcinoma head of pancreas
ERCP
- Double duct sign in carcinoma head of pancreas.
BARIUM ENEMAClaw sign (Pitch fork sign) in intussusception.
FIRST SIGNS
1) First sign of puberty in males Testicular growth
EARLIEST SIGNS
a) Earliest radiological sign of rickets is widening of epiphysis
b) 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 of
normal onychodermal angle is a reliable sign)
- Early sign in scurvy is seen around the knees
The 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 SIGN
Osteomyelitis-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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