SERENITY NOW Posted July 5, 2014 Share Posted July 5, 2014 I find unique physical exam signs really interesting, and its so exciting when you catch one in clinic. I figured it would be fun to have us students share some of our favorite, thereby expanding our repetoire a bit. Post your favorite physical exam findings/signs, and include a picture or a link to one if possible. "Chipmunk facies" -- swelling of the parotid, often indicating repeated emesis as in bulimia nervosa. note - can also indicate thallasemia. "Frank's sign" - diagonal earlobe crease - associated with coronary artery disease. http://www.nejm.org/doi/full/10.1056/NEJMicm1213868 "Smooth philtrum" of fetal alcohol syndrome "Arcus senilis" -- a smooth, light colored, opaque ring around the edge of the cornea that is associated with hypercholesterolemia. Can be common in elderly, but if found in patients under 50, they should get a lipid profile. http://www.medscape.com/viewarticle/721778_11 Link to comment Share on other sites More sharing options...
alster Posted July 5, 2014 Share Posted July 5, 2014 I'm not a student yet (starting next month!!), but I can already tell this will be one of my favorite threads. Can't wait to start adding to it myself! Link to comment Share on other sites More sharing options...
winterallsummer Posted July 5, 2014 Share Posted July 5, 2014 It is always fun to find a new heart murmur especially if you can determine or guess on what it represents based on its characteristics. Anyway my favorite is finding a sign on the hands inductive of systemic disease. I rotated with a doc who's exam always began by inspecting the patients hands and fingernails, usually without the patient noticing. Everything from the impossible to ignore yellow fingernails of yellow nail syndrome (a lung disease), pitting for psoriasis, meurcke's nails of nephrotic disease, clubbing of end stage lung carcinoma to long standing carpal tunnel (thenar wasting) can be diagnosed or suspected with a glance. I recently saw a patient in the hospital suffering from numerous complications of cirrhosis. She was a non drinker without malignancy, a handful of autoimmune diseases but none responsible for her end stage liver disease, and on very little medication. A slew of doctors had seen her for her cirrhosis and reported that no one knew why she had it but they all chocked it down to some autoimmune process. A heme doc was consulted to address her bleeding vs clotting and not her liver. He took one look at her ulnar deviation and in what had confounded her primary team for days determined she had MTX induced liver failure. Link to comment Share on other sites More sharing options...
winterallsummer Posted July 5, 2014 Share Posted July 5, 2014 Note - this dx was later confirmed to be true per history from her family and old hospital records. While everyone else poured over her abdominal ct and labs this doc solved her diagnosis simply through inspection. Link to comment Share on other sites More sharing options...
SERENITY NOW Posted July 5, 2014 Author Share Posted July 5, 2014 That is a very cool story. I think with so many diagnostic tests and imaging studies available, it is very easy to defer to those especially when pushed for time, but in doing so you'll let your own diagnostic skills atrophy. I find the idea of being perceptive to the subtle clues right in front of me a much more exciting way to practice. I grew up reading the original Sherlock Holmes stories and I LOVED the picture painted of this man who could deduce so much from simply being perceptive to the little details that everyone else ignored. When I found out that Sir Arthur Conan Doyle based Holmes on a physician/professor from his medical school I definitely saw medicine in a different light. We all have the chance to be like that! Who else has some favorite findings to share?! Link to comment Share on other sites More sharing options...
Corpsman2PA Posted July 8, 2014 Share Posted July 8, 2014 We get a lot of patients that just started insurance. Nothing like telling them their chronic red-eye is curable. Pterygium-aka "surfers eye" typically benign, but can affect vision. Give some lubricating drops and refer to Ophthalmology. Link to comment Share on other sites More sharing options...
girlyEMT92 Posted July 12, 2014 Share Posted July 12, 2014 Hippus phenomenon AKA pupillary athetosis: when uniform illumination of the pupil produces rhythmic dilation and contraction of that pupil. It can be benign, but it is also related to: transtenetorial herniation, seizures, cerebral tumors, and a few more things. Check it out... https://www.youtube.com/watch?v=MqnTZb-LY9g Link to comment Share on other sites More sharing options...
SERENITY NOW Posted July 15, 2014 Author Share Posted July 15, 2014 oh now that is COOL!!!! thanks girlyEMT92! Link to comment Share on other sites More sharing options...
whoRyou Posted July 15, 2014 Share Posted July 15, 2014 That's awesome! Link to comment Share on other sites More sharing options...
whoRyou Posted July 15, 2014 Share Posted July 15, 2014 Not being a PA, yet, but reading and doing some research I found this interesting. Down's syndrome: Single palmar crease (Simian crease). The fifth digit is abnormally short (only reaches the second crease of the 4th digit). Link to comment Share on other sites More sharing options...
cinntsp Posted July 15, 2014 Share Posted July 15, 2014 Not being a PA, yet, but reading and doing some research I found this interesting. Down's syndrome: Single palmar crease (Simian crease). The fifth digit is abnormally short (only reaches the second crease of the 4th digit). When this came up in class, my friend sitting next to me and I both looked down at our hands, then at each other, then back down and both had an "oh crap" moment. Luckily this can be a normal variant. Link to comment Share on other sites More sharing options...
SERENITY NOW Posted July 31, 2014 Author Share Posted July 31, 2014 Another cool one I caught in a patient today... Palmar erythema: I didn't know much about the history of this patient before I went to see him. I saw this on the physical exam, remembered it could mean something, googled it and found that it is often associated with liver disease. Sure enough when I went back to look at his chart he did have liver disease. I think its a pretty interesting finding! Any others you all have seen? Keep the list growing! Link to comment Share on other sites More sharing options...
Deanj59 Posted July 31, 2014 Share Posted July 31, 2014 Another cool one I caught in a patient today... Palmar erythema: I didn't know much about the history of this patient before I went to see him. I saw this on the physical exam, remembered it could mean something, googled it and found that it is often associated with liver disease. Sure enough when I went back to look at his chart he did have liver disease. I think its a pretty interesting finding! Any others you all have seen? Keep the list growing! Caput Medusa and spider angiomas are also signs of liver failure, typically from alcohol abuse. Link to comment Share on other sites More sharing options...
Deanj59 Posted July 31, 2014 Share Posted July 31, 2014 One of the most interesting I came across was while watching an ER episode, which lead me to look up more info on it. The palmomental reflex is tested by stroking the thenar eminence causes an involuntary contraction of the mentalis muscle, which is meant to indicate cerebral pathology: However, it lacks sensitivity and specificity best I could tell: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1738000/pdf/v073p00113.pdf Cool nonetheless... Link to comment Share on other sites More sharing options...
waky02 Posted July 31, 2014 Share Posted July 31, 2014 Love the Hamburger sign I found it to be fairly sensitive to GI issues in urgent care (I know it's not a real sign but...) Link to comment Share on other sites More sharing options...
Moderator LT_Oneal_PAC Posted July 31, 2014 Moderator Share Posted July 31, 2014 Prehn sign and cremaster reflex. Link to comment Share on other sites More sharing options...
Moderator LT_Oneal_PAC Posted July 31, 2014 Moderator Share Posted July 31, 2014 Also the O sign and Q sign. Link to comment Share on other sites More sharing options...
whoRyou Posted August 1, 2014 Share Posted August 1, 2014 Weaver Syndrome is characterized by rapid growth. Usually starting before birth (prenatal onset), physical growth and bone development (maturation) can occur more quickly than average. Other symptoms can include increased muscle tone (hypertonia) with exaggerated reflexes (spasticity), slow development of voluntary movements (psychomotor retardation), specific physical characteristics, and/or foot deformities. Babies with this syndrome have a hoarse low-pitched cry. Source: http://rarediseases.org http://www.dailymail.co.uk/news/article-2687892/Turkish-girl-17-stands-7ft-tall-officially-declared-worlds-tallest-teenager-Guinness-World-Records.html Link to comment Share on other sites More sharing options...
whoRyou Posted January 8, 2015 Share Posted January 8, 2015 http://espn.go.com/video/clip?id=espn:11914982 Schwartz Jampel Syndrome ... I dare anyone to watch this and try NOT to cry (click or copy and paste the above link) Link to comment Share on other sites More sharing options...
SHU-CH Posted January 9, 2015 Share Posted January 9, 2015 I know it is not a "sign" but you have not lived until you have seen a patient come into the ER experiencing an oculogyric crisis. I think the differential diagnosis includes demonic possession. Link to comment Share on other sites More sharing options...
whoRyou Posted January 9, 2015 Share Posted January 9, 2015 SHU-CH: Thank you; very informative Link to comment Share on other sites More sharing options...
SERENITY NOW Posted August 13, 2015 Author Share Posted August 13, 2015 An anesthesiologist showed me Pemberton's sign in a patient with lung cancer, indicating it was also causing superior vena cava syndrome. Pemberton's sign: The maneuver is achieved by having the patient elevate both arms until they touch the sides of the face. A positive Pemberton's sign is marked by the presence of facial congestion and cyanosis, as well as respiratory distress after approximately one minute. Link to comment Share on other sites More sharing options...
SERENITY NOW Posted September 17, 2017 Author Share Posted September 17, 2017 Heard a good lecture from spine surgeon who shared some practical tips for how to localize where you are going to MRI in a patient with s/s of spinal cord involvement (they generally frown on getting total spine MRI unless if you have suspicion for epidural abscess). Most of the time patients are complaining of low back pain and lower extremity radicular symptoms... other times their symptoms are not so specific and it is hard to figure out where exactly you need to image.... BUT if they have a positive Hoffman's Sign, you should think that the lesion may be higher than lumbar spine, and consider C spine imaging. Supposedly this sign represents hyperreflexia of the upper extremity stemming from UMN injury in cervical spine. It can also be seen as a normal variant, so must be taken into consideration with whole clinical picture. Hoffmann sign is elicited by flicking the nail of the middle finger. Any flexion of the ipsilateral thumb and/or index finger is considered positive, indicating possible cord injury around the level of cervical spine. Link to comment Share on other sites More sharing options...
PACShrink Posted September 17, 2017 Share Posted September 17, 2017 On 7/15/2014 at 7:11 AM, cinntsp said: When this came up in class, my friend sitting next to me and I both looked down at our hands, then at each other, then back down and both had an "oh crap" moment. Luckily this can be a normal variant. ROTFLOL I actually started laughing out loud (Literally) when I read this... Good Stuff !! Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted September 17, 2017 Share Posted September 17, 2017 Heard a good lecture from spine surgeon who shared some practical tips for how to localize where you are going to MRI in a patient with s/s of spinal cord involvement (they generally frown on getting total spine MRI unless if you have suspicion for epidural abscess). Most of the time patients are complaining of low back pain and lower extremity radicular symptoms... other times their symptoms are not so specific and it is hard to figure out where exactly you need to image.... BUT if they have a positive Hoffman's Sign, you should think that the lesion may be higher than lumbar spine, and consider C spine imaging. Supposedly this sign represents hyperreflexia of the upper extremity stemming from UMN injury in cervical spine. It can also be seen as a normal variant, so must be taken into consideration with whole clinical picture. Hoffmann sign is elicited by flicking the nail of the middle finger. Any flexion of the ipsilateral thumb and/or index finger is considered positive, indicating possible cord injury around the level of cervical spine. Very quick/simple test and one of those "you see it, you will know it" findings. Sent from my iPad using Tapatalk Link to comment Share on other sites More sharing options...
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