Signs

Daniel Podd RPA-C

Beau's lines

Strawberry tongue

Peripheral papular or punctate rash

Sandpaper rash

Pastia's lines

Scarlet Fever

Nikolsky's sign

Pemphigus vulgaris

Toxic Epidermal Necrolysis

Staphylococcal scalded skin syndrome

Osler's nodes

Splinter Hemorrhages

Janeway lesions

Roth Spots

Subacute Bacterial Endocarditis

Heberden's node

Osteoarthritis

Bouchard's nodes

Osteoarthritis

Boutonnieres deformity

Swan neck deformity

Subcutaneous nodules

Pannus formation

Rheumatoid arthritis

Skin contractures, “mask-like face”; (calcinosis, Raynaud phenomenon,

esophageal dysmotility, sclerodactyly, telangiectasias)

Systemic Sclerosis (limited)

Fever, malar rash, splenomegaly, uveitis

Vasculitis

Oral ulcers

Pancytopenia(Thrombocytopenia)

SLE

Needle-shaped,

Negatively birefringent

monosodium urate crystals

Gouty Arthritis

Rhomboid-shaped, calcium pyrophosphate

dihydrate crystals,positively

birefringent

Pseudogout

Negative Nikolsky's sign

Bullous Pemphigoid

“Stuck on” Papules or Plaques

Seborrheic Keratosis

“Target lesions”

Erythema Multiforme

“A rash that itches”

Atopic Dermatitis/Eczema

Sharply demarcated bright pink plaques with overlying loose “silvery scale”; positive

Auspitz sign & Koebner phenomenon

Psoriasis

“Honey-colored crusts”

Impetigo

“Polygonal, Purple, Pruritic, Papular”

Lichen Planus

Erythema, scaly, oily skin

Seborrheic Dermatitis

Erythema (rubor), swelling (tumor), local tenderness (dolor), warm to touch (calor);

flat and without sharp demarcation

Cellulitis

Shiny, bright red erythema; Indurated, elevated, tender, hot, edematous;

irregular border sharply demarcated

Erysipelas

Flushing, telangiectasis,

papules/ pustules,rhinophyma

Acne Rosacea

Herald patch progressing to Christmas-tree papular/plaques

Pityriasis Rosea

“Dewdrop on a rose petal”

Varicella

“Pruritic, ring-shaped, erythematous, scaling plaques”

Tinea Corporis

“Pearly, fine telangiectasias, rodent ulcer”

Basal Cell Carcinoma

Asymmetic, Borders Irregular, Mottled Color, Diameter > 6mm,

Elevated

Melanoma

Kayser-Fleischer ring

Wilson’s Disease

Red eye: “Fixed, mid-dilated pupils, steamy/cloudy cornea”

Acute angle closure glaucoma

Copious watery, purulent discharge; conjunctival injection/beefy red conjunctiva

Bacterial conjunctivitis

Red eye: “ciliary flush”, small/constricted, and poorly reactive pupils

Anterior Uveitis

External, erythematous, swollen, tender mass on lid margin

Hordeolum

Small, nontender “English pea” nodule internally on lid

Chalazion

Pain and limitation of EOMs, proptosis, chemosis, decreased visual acuity

Orbital Cellulitis

Hyperemic, exudative tonsils, posterior cervical LAD, fever, palatal petechiae,

hepatosplenomegaly

Mononucleosis

Levine’s sign, tachycardia, S4

gallop hyper/hypotension,

diaphoresis, tachypnea, pallor, cool/clammy skin, low-grade fever

Acute Coronary Syndrome/AMI

S3 gallop, laterally displaced PMI, rales, altered mental status, cool extremities,

delayed capillary refill, tachypnea, hypertension, Pulsus alternans…

Pulmonary venous congestion

Kerley B lines

CXR

EKG

LBBB

LVH Q-waves

Left Axis Deviation

CHF: LV Failure

Which can progress to…

CXR

“Bat-winged” or “Butterfly pattern”

Pulmonary Edema

Peripheral edema, jugular venous distention, tachycardia,

hepatosplenomegaly, ascites, hemorrhoids

Caput medusa

EKG: Right Ventricular Hypertrophy

“Poor R-wave progression” and deep S waves in V leads

R axis deviation

CHF: RV Failure

Fever, left lower sternal border friction rub, tachycardia

Patient’s position of relief

“Diffuse ST-segment elevations”

Pericarditis

Kussmaul’s sign, Pulsus Paradoxus,cool clammy skin, tachycardia, distant heart

sounds, friction rub, hypotension, pulsus alternans, and JVD…

EKG: Tachycardia, low voltage QRS, and

electrical alternans

“Water bottle” heart

Cardiac Tamponade

Murmurs

Low-pitched apical diastolic murmur“Opening Snap”

Accentuated in left lateral decubitus & after exercise

Mitral Stenosis

High-pitched, blowing diastolic murmur, 2nd- 4th left interspaces

Radiation to apex, RSB Accentuated: Patient

sitting/leaning forward, exhalation

Aortic Regurgitation

Blowing, holosystolic murmur at apex

Radiation to left axilla, LSBMedium-high pitch

Mitral Regurgitation

Harsh crescendo-decrescendo, medium pitched systolic murmur at

right 2nd interspaceRadiation to neck

Accentuated: patient sitting/leaning forward

Aortic Stenosis

“Midsystolic click”; murmur prolonged with Valsalva and decreased with squatting

Mitral Valve Prolapse

Double apical impulse, paradoxically split S2, prominent jugular ‘a’ waves, systolic ejection murmur @ apex or left sternal

border that ↑ with standing and Valsalva (reduced preload) and ↓ with squatting

(increased preload)…

+ Family history of sudden death…

Hypertrophic Cardiomyopathy

LVH

acute anterior lateral myocardial infarction

Primary AV block

“Bird’s Beak”

Achalasia

Cullen’s Sign

Grey-Turner’s sign

Sentinel loop sign

Colon cut-off sign

Acute Pancreatitis

“Discontinuous (skip lesions),

transmural inflammation,

cobblestoning”

Crohn’s Disease

“Continuous, Colonic (rectal), Coating (mucosa/submucosa)”

Ulcerative Colitis

Obturator sign

Psoas sign

RLQ pain/McBurney’s Point tenderness + rebound tenderness

Also: Rovsing’s sign, fever, cutaneous hyperesthesias, abdominal guarding

Appendicitis

Dental erosions, oropharyngeal inflammation; hx of burning retrosternal chest pain provoked by supine position

and regurgitation of digested food

Upper Endoscopy

GERD (with progression to Barrett’s esophagus)

Mid-epigastric pain, deep recurring ache that is relieved with food or antacids; positive

hemoccult blood; hx of nocturnal pain (1-2 am)

Upper Endoscopy

+ Urea breath test

+ ELISA for IgG toHelicobacter pylori

Duodenal Ulcer (H. pylori induced)

Mid-epigastric pain that is relieved by antacids but aggravated by food; hx of

severe osteoarthritis, CAD, EtOH abuse, and cigarette smoking

Upper Endoscopy

Negative H. pylori diagnostics

Peptic Ulcer Disease (gastric irritant/NSAID induced)…

…a history of either ulcer disease process, with presentation of:

• sudden, “exact-timing” upper quadrant to generalized abdominal pain• signs/symptoms of shock• peritoneal signs

“Free air under the diaphragm”

Perforated Ulcer/Viscus

Fever/chills, RUQ, jaundice; tachycardia, hypoactive bowel sounds,

toxic appearance, + Murphy’s sign

RUQ sonogram

Acute Cholecystitis

Charcot’s triad + shock/hypotension and altered mental status = Reynolds' pentad…Dx?

Acute cholangitis

Erythema Migrans

Hepatitis B Serology

The first clinically detectable serological agent in acute hepatitis B is…

HBsAg

Appears after successful clearance of HBsAg or after HepB

vaccination…

Anti-HBs

Implies highly infectious state, found in acute or chronic HepB…

HBeAg...

While low infectivity/replication is inferred by…

Anti-HBe

Found in window period, signifies acute infection…

IgM anti-HBc (and HBeAg)

Signifies Chronic Hepatitis B, without recovery…

IgG anti-HBc and HBsAg

Signifies Chronic Hepatitis B, WITH recovery/immunity…

IgG anti-HBc and Anti-HBs(HBsAg and HBeAg negative)

The only positive serological marker in HepB vaccination…

Anti-HBs

Primary Lyme Disease

Fever; initial macular rash on periphery…

…Later: Central Papules and Petechiae

Rocky Mountain Spotted Fever

Productive rust-colored cough, fever, tachypnea,

rigors, ill appearance

Pulmonary Exam: Decreased breath sounds, increased fremitus, rales, + bronchophony, egophony, whispered pectoriloquy

Pneumococcal Pneumonia

…In the chronically ill

Staphylococcal Pneumonia

Slowly progressive fatigue, malaise, arthralgias, fever; dry/nonproductive cough; URI symptoms

(otalgia & pharyngitis)

Pulmonary exam: Wheezing, scattered rhonchi, basilar rales

Serous Otitis Media

bilateral diffuse hazy infiltrates

Mycoplasma (walking) pneumonia

Unilateral absent breath

sounds, ipsilateral atelectasis

Hyperresonant to percussion,

decreased fremitus

Pneumothorax

Wheezing, nocturnal cough, pulsus paradoxus; history of atopic dermatitis

& allergic rhinitis

Increased bronchial wall markings

Flattening of diaphragm

Hyperinflation

Asthma

Tachypnea/cardia, rales, fever, unilateral lower extremity edema,

venous cords…

EKG: sinus tachycardia, “S1 Q3 T3”, RBBB…

CXR: Elevated hemidiaphragm,

Hampton's hump,

Westmark sign…

V-Q Mismatching

Pulmonary Embolism

Hyperinflated (barrel chest), wheezing, crackles, diffusely decreased breath

sounds, hyperresonance on percussion, prolonged expiration, cyanosis, accessory

muscle of respiration use…

PFT: Reduced FEV1

CXR:Lung hyperinflation

Diaphragm flattening

Distal pulmonary vessel tapering

Increased basilar markings

COPD

Bulging TM, increased vascularity, erythema, distortion of normal

landmarks, immobile to insufflation

AOM

Tenderness on pinna

palpation/auricle traction;

edema, purulent discharge

Otitis externa

Waters view: opacification, air-fluid levels, thickened mucosa

Maxillary Sinusitis

Soft white plaques,

erythematous, bleeding base

Oral Candidiasis

Thick, white patch, adherent

Leukoplakia

Irregular, raised white-pink cauliflower lesion

Condyloma acuminata

Tender! vesicles ulcerations, grouped lesions common and may

coalesce; regional LAD, fever

Herpes Simplex Virus (II)

PainlessSolitaryChancre

Primary Syphilis

Condyloma Lata

Secondary Syphilis

Granulomatous Gummas

Tertiary Syphilis

“Bronze Diabetes” + Cirrhosis

Iron Deposits

Hemochromatosis

CD4+ < 200, fever, nonproductive cough, rales/rhonchi, bibasilar crackles, respiratory

distress

Bilateral Interstitial Infiltrates

Pneumocystis carinii pneumonia (PCP)

Good Luck!!!