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PHYSICAL SIGNS
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Sign Description, Finding Indication

Doll's Eye Sign Dissociation between movement of the eyes and of the
head. Eyes moves up and head moves down.
Babinski's Sign Fanning of big toe when you stroke the plantar aspect CNS: Pyramidal Tract Lesion
of the foot
Chaddock's Sign Great toe fanning when you touch the external CNS: Corticospinal tract
malleolar skin lesions
Eyelash Sign Stroking eyelash produces no movement of lids. CNS: Organic stroke.

Stroking eyelash produces movement of lids. CNS: Functional hysteria

Hoffman's Sign Nipping nail of middle finger cause flexion of terminal CNS: Pyramidal Tract
phalanx of thumb. Unilaterally. Disease
Digital Reflex
Clenched Fist Holding clenched fist over chest to describe CV: Angina Pectoris
(Levine's) Sign constricting, pressing pain
de Musset's Sign Rhythmic jerking movement of the head CV: Aortic Insufficiency
Ewart's Sign Dullness, bronchial breathing, bronchophony over the CV: Pericardial effusion
angle of the left scapula.
Hamman's Sign Crunching sound synchronous with heartbeat. CV: Mediastinal Emphy-
sema, Pneumopericardium
Hill's Sign Exaggerated femoral artery systolic pressure (60 to CV: Aortic Insufficiency
100 mm Hg higher) over brachial systolic pressure.
Homan's Sign Pain in back of calf or knee when foot is dorsiflexed. CV: Thrombosis in veins of
calf
Kussmaul's Sign Paradoxical increase in jugular venous distension CV: Cardiac Tamponade
when patient inspires.
Osler's Sign Painful erythematous swellings in skin and CV: Endocarditis
subcutaneous tissues of hands and feet.
Joffroy's Sign No forehead wrinkling when the eyeballs are rolled Endocrine: Grave's Disease
upward.
Möbius Sign Impaired ocular convergence (accommodation) Endocrine: Grave's Disease
Stellwag's Sign Infrequent and incomplete blinking. Endocrine: Grave's Disease
Kestenbaum's Sign Decrease in number of arterioles crossing optic disk Eye: Optic Atrophy
margins.
Marcus Gunn Flashlight swung from one eye to the other eye, then Eye: Cataract, optic nerve
Pupillary Sign both pupils dilate (when they should constrict). defects
Cullen's Sign Periumbilical darkening of the skin GI: Intraperitoneal
hemorrhage, from
hemorrhagic pancreatitis or
ectopic pregnancy
Grey Turner's Sign Local discoloration of the skin of the loins GI: Acute hemorrhagic
pancreatitis
Groove Sign Firm nodes in groin above and below inguinal GI: Lymphogranuloma
ligament, with a groove along the ligament. Venereum
Kehr's Sign Violent pain in the left shoulder GI: Ruptured Spleen
Puddle Sign Patient gets on all fours, and palpating at one end GI: Ascites
allows auscultation at the other end of the abdomen.
 Stethoscope moves from most dependent position
gradually contralaterally.
Rovsing's Sign Pain in right abdomen at McBurney's Point when GI: Appendicitis
pressure is exerted on left abdomen.
Bárány's Sign Irrigate ear with cold water: should lead to nystagmus Head and Neck: Labyrinthine
on opposite side. disease, such as Meniere's
Disease
Irrigate ear with warm water: should lead to
nystagmus on same side.

This sign shows no nystagmus

Battle's Sign Postauricular ecchymosis Head and Neck: fracture of
the base of the of the skull.
Brudzinski's Sign (1) Contralateral leg reflex: passive flexion of leg on Infectious: Meningitis
one side elicits reflex on the opposite side.

(2) Passively flex neck, and hips and knees flex

spontaneously.
Kernig's Sign Patient lies on back and flexes thigh upward, then Infectious: Meningitis
complete extension of leg is impossible.
Pastia's Sign Hemorrhagic transverse lines at bend of elbow, wrist, Infectious: Scarlet Fever
or inguinal region. It persists after desquamation.
Romberg's Sign Close eyes and lose gait; ataxia. Infectious: Tabes Dorsalis
Winterbottom's Sign Swelling of posterior cervical lymph nodes. Infectious: African Sleeping
Sickness (Trypanosomiasis)
Chvostek's Sign Facial irritability. Unilateral spasm induced by tap Muscular: Tetany
over the facial nerve.
Trousseau's Sign Upper arm compressed by a tourniquet or blood- Muscular: Tetany
pressure cuff causes carpal spasm.
Braxton Hicks Irregular uterine contractions after third month of OB/GYN: Pregnancy
Contractions pregnancy.
Chadwick's Sign Bluish discoloration of cervix and vagina OB/GYN: Pregnancy
Drawer Sign Forward sliding (anterior cruciate) or backward sliding Skeletal: Disruption of
(posterior cruciate) of the tibia. anterior (forward slide) or
posterior (backward slide)
cruciate ligaments of knee.
Lasègue's Sign When patient is supine with hip flexed up, Skeletal: Sciatic Nerve
dorsiflexion of the ankle causes pain. irritation (Sciatica)
Nikolsky's Sign Sliding pressure of thumb pressed against skin Skin: Pemphis Vulgaris
separates outer layer from basal dermis.

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SYNDROMES
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Organized by Category:

• Environmental Causes
• Cardiovascular
• Iatrogenic
• Neoplastic
• Congenital
• Endocrine
• Pulmonary
• Infectious
• Renal
• Neurological
• Gastrointestinal
 • Reticulo-endothelial, Hematologic
• Uncategorized

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ENVIRONMENTAL CAUSES

• ACUTE RADIATION SYNDROME: Radiation exposure.

o 12 hours post-exposure: Vomiting
o 24 hours post-exposure: Prostration (extreme exhaustion), fever, diarrhea
o Later: Petechial hemorrhage, hypotension, tachycardia, profuse bloody diarrhea, maybe death.
• CHINESE RESTAURANT SYNDROME: MSG reaction ------> Chest Pain, burning sensation over
parts of body.
• BROWN-SEQUARD SYNDROME: Damage (injury) to half of spinal cord ------> symptoms:
o Loss of pain and temperature sensation on contralateral side of body.
o Loss of proprioception and discriminatory touch on ipsilateral side of body.

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CARDIOVASCULAR

• ADAMS-STOKES SYNDROME: Heart block, with slow or absent pulse, often accompanied by
convulsions.
• BARLOW SYNDROME: Floppy Mitral Valve Syndrome; Massive Mitral Valve Prolapse ------>
Late apical systolic murmur, systolic click, or both.
• EISENMENGER'S SYNDROME: Ventricular-Septal Defect ------> Pulmonary hypertension and
cyanosis.
• FLOPPY-VALVE SYNDROME: Mitral Incompetence due to myxomatous degeneration of the
leaflets.
• LERICHE'S SYNDROME: Occlusion of distal aorta ------>
o Hip, thigh, and calf fatigue.
o Impotence
 • BEHCET'S SYNDROME: Vasculitis ------> secondary symptoms:
o Oral and genital ulcers
o Uveitis
o Optic atrophy
• SHOULDER-HAND SYNDROME: Pain in shoulder and swelling in hand, sometimes occurring after
Myocardial Infarction.
• SICK SINUS SYNDROME: Chaotic atrial activity; continual changes in P-Waves. Bradycardia,
alternating with recurrent ectopic beats and runs of tachycardia.
• SUPERIOR VENA CAVA SYNDROME: Caused by a tumor. Obstruction of SVC ------>
o Edema
o Engorgement of the vessels of face, neck, and arms.
o Nonproductive cough
o Dyspnea
• TAKAYASU'S SYNDROME: Arteritis of the Aortic Arch, resulting in no pulse. Seen in young women.
• WOLF-PARKINSON WHITE SYNDROME: ECG pattern of Paroxysmal Tachycardia.
o Short PR interval
o Delta wave = early QRS complex.

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IATROGENIC (or Secondary to Medical Treatment)

• AFFERENT LOOP SYNDROME: Gastrojejunal loop obstruction, proximal to a gastrojejunostomy.

o Ingestion of food produces nausea, pain, and duodenal distension.
• ASHERMAN'S SYNDROME: Adhesions within the endometrial cavity, causing amenorrhea and
infertility.
o Adhesions probably were caused by surgery.
• ULYSSES SYNDROME: Ill effects from follow-up diagnostic tests following a false-positive
screening test.

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NEOPLASTIC (Malignant or Benign)

• CARCINOID SYNDROME: Carcinoid tumor producing Bradykinin + Serotonin ------> secondary

symptoms:
o Cyanotic flushing
o Diarrhea
o Bronchial spasm
o Edema, ascites.
• CRONKHITE-CANADA SYNDROME: GI-Polyps with diffuse alopecia (hair-loss) and nail
dystrophy.
o May see protein-losing enteropathy and malabsorption.
• GARDNER'S SYNDROME: Multiple inherited tumors, hereditary dominant trait.
o Skull osteomas, Fibromas, Epidermoid cysts
o Colonic polyposis (APC gene) ------> predisposition to colonic adenocarcinoma.
• LAMBERT-EATON SYNDROME: Progressive proximal muscle weakness secondary to a carcinoma.
• MEIGS' SYNDROME: Fibroma of ovary with ascites and hydrothorax
• PANCOAST SYNDROME: Tumor near pulmonary apex ------>
o Neuritic pain of chest and arm
o Muscle atrophy of the arm
o Horner's Syndrome (impaired cervical sympathetics)
• PEUTZ-JEGHERS SYNDROME: Polyposis (hamartomas) of small intestine
o Also see melanin pigmentation of buccal mucosa and skin around mouth and lips

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CONGENITAL

• CEREBELLAR SYNDROME: Congenital Cerebellar Ataxia

• CERVICAL SYNDROME: Supernumerary C7 rib ------> Pressure on brachial plexus ------> pain
radiating over shoulder, arm, and forearm over C7 distribution.
• DANDY-WALKER SYNDROME: Obstruction of Foramina of Magendie and Luschka in infants ------
> Hydrocephalus.
• DIGEORGE SYNDROME: Congenital absence of 3rd and 4th Branchial Arches (Thymus and
Parathyroid Glands) ------> secondary symptoms:
o No cell-mediated immunity ------> Frequent viral and fungal infections
 o Characteristic facial deformities
• DOWN SYNDROME: Trisomy 21. Mental retardation, characteristic facial features, Simeon crease in
hand.
• FANCONI'S SYNDROME Type I: Bone-marrow hypoplasia ------> refractory anemia, pancytopenia.
• EHLERS-DANLOS SYNDROME: Congenital defect in collagen.
o Hyper-elasticity and friability of the skin.
o Hyperextensibility of the joints.
• FETAL ALCOHOL SYNDROME: Fetal malformations, growth deficiencies, craniofacial anomalies,
limb defects.
• GOODPASTURE'S SYNDROME: Autoantibodies against basement membranes ------>
Glomerulonephritis (kidney) and hemoptysis (lungs).
o Often, death by renal failure
• KLINEFELTER'S SYNDROME: Trisomy XXY ------> testicular atrophy, increase in gonadotropins
in urine.
• KLIPPEL-FEIL SYNDROME:
o Cervical vertebrate fused
o Congenital short neck, limited neck rotation
o Abnormalities of the brainstem and cerebellum
o Low hairline.
• LESCH-NYHAN SYNDROME: Deficiency of HGPRT (Hypoxanthine-Guanine Phospho-
ribosyltransferase ------>
o Hyperuricemia, uric acid kidney stones
o Choreoathetosis
o Mental retardation, autism, spastic cerebral palsy
o X-Linked recessive
• MARFAN SYNDROME: Connective Tissue disorder ------>
o Arachnodactyly: Abnormally long digits and extremities
o Subluxation of lens
o Dissecting aortic aneurism
• POSTRUBELLA SYNDROME: Infantile defects resulting from maternal Rubella infection during
first trimester.
o Microphthalmos, cataracts
o Deafness
o Mental retardation
o Patent ductus arteriosis, Pulmonary arterial stenosis
• PRADER-WILLI SYNDROME: Short stature, mental retardation, polyphagia with marked obesity,
sexual infantilism.
 • RENDU-OSLER-WEBER SYNDROME: Hereditary hemorrhagic telangiectasia.
• SUDDEN INFANT DEATH SYNDROME: Unexplained death in sleeping infants.
• TURNER'S SYNDROME: XO monosomy.
o Dwarfism
o Webbed neck
o Valgus of elbow.
o Amenorrhea
• WILSON SYNDROME: Congenital defect in Ceruloplasmin, leading to buildup of copper ------>
mental retardation, cirrhosis, hepatolenticular degeneration.

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ENDOCRINE, REPRODUCTIVE

• AMENNORRHEA-GALACTORRHEA SYNDROME: Non-physiologic lactation, resulting from

endocrinologic causes or from a pituitary disorder.
• CONN'S SYNDROME: Primary Hyperaldosteronism ------> muscular weakness, hypertension,
hypokalemia, alkalosis.
• CUSHING'S SYNDROME: Hypersecretion of cortisol ------> secondary symptoms and
characteristics:
o Fatness of face and trunk with wasting of extremities
o Buffalo hump
o Bone decalacification
o Corticoid diabetes
o Hypertension
• PREMENSTRUAL SYNDROME: Abnormal sensation in breasts, abdominal pain, thirst, headache,
pelvic congestion, nervous irritability.
o Ocassionally nausea and vomiting.
• SHEEHAN'S SYNDROME: Post-partum pituitary necrosis ------> hypopituitarism.
• STEIN-LEVENTHAL SYNDROME: Polycystic ovary ------> infertility, amenorrhea, hirsutism. Seen
in obese women.
• TESTICULAR FEMINIZATION SYNDROME: Insensitivity to Testosterone. Male
Psuedohermaphroditism
o Complete female external genatalia, incompletely developed vagina, rudimentary uterus.
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PULMONARY

• KARTAGENER'S SYNDROME: Situs Inversus (lateral transposition of lungs) resulting from chronic
sinusitis and bronchiectasis.
• HAMMAN-RICH SYNDROME: Interstitial fibrosis of the lung.
• MIDDLE-LOBE SYNDROME: Chronic pneumonitis and atalectasis of middle lobe of right lung.
• CHURG-STRAUSS SYNDROME: Allergic Granulomatous Angiitis: Asthma, fever, eosinophilia.

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INFECTIOUS

• FITZ-HUGH-CURTIS SYNDROME: Gonococcal Periphepatitis in woman, as a complication of

Gonorrhea.
• GUILLAN-BARRE SYNDROME: Infectious Polyneuritis of unknown cause.
• HUNT'S SYNDROME: Herpe's Zoster infection of Facial Nerve (CN VII) and Geniculate Ganglion
------> facial palsy.
o Zoster of ear
• REYE'S SYNDROME: Loss of consciousness and seizures in kids, after a viral infection treated by
aspirin.
• REITER'S SYNDROME: Symptom cluster. Etiology is thought to be Chlamydial or post-chlamydial.
o Urethritis
o Iridocyclitis (Conjunctivitis)
o Arthritis
o Skin lesions like karatoderma blenorrhagicum
o Also can see fatty liver or liver necrosis.
• SCALDED SKIN SYNDROME: S. Aureus toxic epidermal necrolysis.
• STEVENS-JOHNSON SYNDROME: Erythema Multiforme complication.
o Large areas of skin slough, including mouth and anogenital membranes.
o Mucous membranes: stomatitis, urethritis, conjunctivitis.
o Headache, fever, malaise.
 • TOXIC SHOCK SYNDROME: Caused by superabsorbent tampons. Infection with Staph Aureus and
subsequent toxicity of exotoxin TSST ------> systemic anaphylaxis.
o Fever, vomiting, diarrhea
o Red rash followed by desquamation
• WATERHOUSE-FRIEDRICHSON SYNDROME: Meningeococcal Meningitis ------> DIC,
hemorrhagic infarct of adrenal glands ------> fulminant adrenal failure.
o Vomiting, diarrhea.
o Shock
o Extensive purpura, cyanosis, circulatory collapse.

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RENAL

• KEMMELSTIEL-WILSON SYNDROME: Diabetic Glomerulosclerosis.

• BARTTER'S SYNDROME: Juxtaglomerular Cell Hyperplasia ------> secondary symptoms:
o Hyperaldosteronism, Hypokalemic Alkalosis, elevated renin and angiotensin
o No hypertension.
o Compare to Conn's Syndrome
• FANCONI'S SYNDROME Type II: Renal aminoaciduria, glycosuria, hypophosphaturia, cysteine
deposition, rickets.
• THORN'S SYNDROME: Salt-losing nephritis.

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NEUROLOGICAL

• CARPAL-TUNNEL SYNDROME: Compression of Median Nerve through the Carpal Tunnel ------>
pain and parasthesia over distribution of Median N.
• FROIN'S SYNDROME: Block in CSF flow ------> xanthochromia (yellow discoloration) of CSF.
• ACUTE-BRAIN SYNDROME: Delirium, confusion, disorientation, developing suddenly in a person
that was previously psychologically normal.
• GERSTMANN'S SYNDROME: Lesion between occipital area and angular gyrus ------> symptoms:
 o Finger agnosia, Agraphia, acalculia
o Right-left disorientation
• HORNER'S SYNDROME: Loss or lesion of cervical sympathetic ganglion ------>
o Ptosis, miosis, anhydrosis
o Enophthalmos (caved in eyes)
• KORSAKOFF SYNDROME: Loss of short-term memory in chronic alcoholism, caused by
degeneration of mamillary bodies.
• RILEY-DAY SYNDROME: Familial dysautonomia.

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GASTROINTESTINAL

• MALLORY-WEISS SYNDROME: Laceration of lower end of esophagus from vomiting ------>

hematemesis. Often seen in alcoholics.
• MALABSORPTION SYNDROME: Impaired absorption of dietary substance ------> diarrhea,
weakness, weight loss, or symptoms from specific deficiencies.
• BARRET SYNDROME: Chronic peptic ulcer of the lower esophagus, resulting in metaplasia of
esophageal columnar epithelium ------> squamous epithelium.
• ZOLLINGER-ELLISOHN SYNDROME: Gastrin-secreting tumor in pancreas ------> Severe peptic
ulcers, gastric hyperacidity.
• PLUMMER-VINSON SYNDROME: Esophageal Webs, leading to dysphagis and atrophy of papillae
of tongue.
o Also see hypochromic anemia, splenomegaly.

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RETICULOENDOTHELIAL, HEMATOLOGIC

• BANTI'S SYNDROME: Chronic Congestive Splenomegaly with anemia, caused by either Portal
Hypertension or Splenic Vein Thrombosis.
• BUD-CHIARI SYNDROME:
o ACUTE: Hepatic Vein Thrombosis ------> Massive ascites and dramatic death.
 o CHRONIC: Gradual hepatomegaly, portal hypertension, nausea, vomiting, edema, ulimately
death.
• DUBIN-JOHNSON SYNDROME: Defect in excretion of conjugated bilirubin ------> recurrent mild
jaundice. Buildup of direct builirubin in blood.
• CHIDIAK-HIGASHI SYNDROME: Abnormalities in leukocytes with large inclusions.

• CRUVEILHIER-BAUMGARTEN SYNDROME: Symptoms cluster:

o Liver cirrhosis
o Caput Medussae
o Venous hum and thrill
• FELTY'S SYNDROME: Rheumatoid Arthritis with splenomegaly, leukopenia, anemia, and
thrombocytopenia.
• LOFFLER'S SYNDROME: Eosinophilia with transient infiltrates in lungs.

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UNCATEGORIZED

• YELLOW-NAIL SYNDROME: Stop growth of nails ------> increased convexity, thickening, and
yellowing of nails.
o Found in Lymphedema, bronchitis, chronic bronchiectasis.
• COSTOCHONDRAL SYNDROME: Pain in chest with tenderness over one or more costochondral
junctions.
o Similar to Tietze's Syndrome but no specific inflammation.
• TIETZE'S SYNDROME: Costochondritis. Swelling and tenderness of the costal cartilege.
• MIKULICZ'S SYNDROME: Salivary and lacrimal enlargement as seen in several diseases:
o Sarcoidosis
o Tuberculosis
o Leukemia
• MUNCHAUSEN SYNDROME: Malingering -- fabrication of a clinically convincing disease by an
itinerant malingerer.
• PICKWICKIAN SYNDROME: Symptom cluster
o Obesity
o Hypoventilation
o Somnolence
 o Erythrocytosis
• RESTLESS LEGS SYNDROME: Need to stretch legs at night before going to sleep; twitch in legs
causing insomnia.
• STRAIGHT BACK SYNDROME: Loss of normal kyphosis of thoracic spine ------>
o Straight spine
o Ejection murmur
o Widened cardiac silouhette on x-ray
• SJÖGREN'S SYNDROME: Autoimmune complex
o Keratoconjuctivitis Sicca (dry eyes and mouth)
o Dryness of Mucous membranes
o Telangiectasias in face
o Parotid enlargement

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HEART MURMURS
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Murmur Description Indication

Cooing Murmur Musical murmur
Holosystolic Murmur Pansystolic murmur
Innocent Murmur Functional murmur without anatomic
abnormality for the murmur.
Musical Murmur Having a musical quality
Pansystolic Murmur Occupies entire interval of systole.
Regurgitant Murmur Caused by leakage of an incompetent heart
valve.
Hemic Murmur Murmur heard, but no valvular lesions. Due Anemia
to blood turbulence.
Flow Murmur
Austin Flint Murmur Presystolic murmur similar to mitral stenosis, Aortic Insufficiency
heard at cardiac apex. Caused by
regurgitation from Aorta partially narrowing
the mitral valve.
Diamond-Shaped Murmur Crescendo-Decrescendo murmur Aortic Stenosis

Pulmonic Stenosis
Early Diastolic Murmur Begins right after the second heart sound. Aortic Insufficiency
Ejection Murmur Diamond-shaped systolic murmur ending Aortic Stenosis
before the second heart sound, produced by
the ejection of blood into the Aorta or Pulmonic Stenosis
Pulmonary Arteries
Cardiopulmonary Murmur Related to movement of the heart, and Innocent
disappearing when the breath is held.
Still's Murmur Innocent musical murmur resembling a Innocent
twanging string
Late Systolic Murmur Diamond-shaped murmur late in systole. Mitral Valve Prolapse (MVP)
Often accompanied by mid or late systolic
click.
Middiastolic Murmur Begins after the AV valves have opened in Mitral Stenosis
diastole.
Presystolic Murmur Occurs during late diastole, caused by Mitral Stenosis
contraction of the atria.
Narrowing of the AV valves
Machinery Murmur Continuous rumbling murmur, heard Patent Ductus Arteriosus
throughout systole and diastole.
Extracardiac Murmur Heard over precordium, but originating from Pericardial Friction Rubs
structures other than the heart
Graham Steele's Murmur Early diastolic murmur heard over Erb's Pulmonic Insufficiency,
Point. secondary to Pulmonary
Hypertension and Mitral
Stenosis.
Roger's Murmur Loud pansystolic murmur maximal at the left Ventricular Septal Defect (VSD)
sternal border.